/HEN TO SEND 
FOR THE DOCTOR 

AND 
WHAT TO DO BEFORE 
THE DOCTOR COMES 



F.E.LIPPERTAND A.HOLMES 




riass // <^ 6/ 
Book ^-^ 



Copyright N°- 



COPYRIGHT DEPOSIT. 



WHEN TO SEND 
FOR THE DOCTOR 

AND 

WHAT TO DO BEFORE 
THE DOCTOR COMES 



^ 



WHEN TO SEND 
FOR THE DOCTOR 

AND 

WHAT TO DO BEFORE 
THE DOCTOR COMES 



BY 
FRIEDA E. LIPPERT, M.D. 

ASSISTANT AT THE PSYCHOLOGICAL CLINIC, UNIVERSITY OF PENNSYLVANIA 

AND 
ARTHUR HOLMES, Ph.D. 

ASSISTANT PROFESSOR OF PSYCHOLOGY AND ASSISTANT DIRECTOR OF THE 
PSYCHOLOGICAL CLINIC, UNIVERSITY OF PENNSYLVANIA 



WITH 16 FULL-PAGE ILLUSTRATIONS AND 
FRONTISPIECE IN COLOR 




PHILADELPHIA & LONDON 
J. B. LIPPINCOTT COMPANY 

1913 



< 



COPYRIGHT, 1913, BY J. B. LIPPINCOTT COMPANY 



PUBLISHED MARCH, 1913 



PRINTED BY J. B. LIPPINCOTT COMPANY 

AT THE WASHINGTON*SQUABE PRESS 

PHILADELPHIA, U. S. A. 



)CJ.A346429 



CONTENTS 



PART I. 

SIMPLE NON-CONTAGIOUS AND 
CONTAGIOUS DISEASES. 

CHAPTER. PAGE. 

I. Baby's Cries 13 

II. Colds , 20 

III . Sobe Throat 31 

IV. Fevers 36 

V. The Sick Stomach 45 

VI. Bowel Troubles 50 

VII. Headache 55 

VIII. Skin Eruption 62 

IX. Contagious Febrile Diseases 79 

X. Contagious Diseases of the Eye 95 

PART II. 

SIMPLE AND SERIOUS NERVE DISORDERS. 
XI. Nervous Diseases 103 

PART III. 

SOME HABITS OF CHILDHOOD. 
XII. Certain Nervous Habits 121 

PART IV. 

PHYSICAL AND MENTAL CAUSES OF 
RETARDATION. 

XIII. Common Physical Defects 136 

XIV. Defective Hearing 144 

XV. Defective Teeth 154 



CONTENTS 

XVI. Defective Speech 160 

XVII. Defects of Posture 162 

XVIII. The Signs of Mental Retardation 177 

PART V. 
WHAT TO DO BEFORE THE DOCTOR COMES. 

XIX. Wounds 217 

XX. Burns and Scalds 228 

XXI. Unconsciousness 234 

XXII. Fractures, Dislocations, Sprains 243 

XXIII. Poisons 250 



ILLUSTRATIONS 



PAGE 

Favus Frontispiece 

Proper Dressing for Young Infant 14 

Examining Child's Throat, with Tablespoon Holding 

Down the Tongue 32 

Position of Infant for Introduction of Thermometer. . 36 

"The History of a Boil" 76 

Chicken-pox. Third Day of Eruption. Baby 4 

Months 88 

Mumps 92 

Lowering Infant into Bath 108 

Dr. Reber's "Kindergarten Test" Card 138 

Front and Side Views of Adenoid Case 148 

How To Look Into the Ear Without Using Instru- 
ments 150 

Crooked, Carious Teeth 154 

Faulty Position in Writing and Studying 164 

Straight Position in Studying at Table 164 

Blue Imprint of Severe Case of Flat-foot 172 

High-grade Imbeciles '. 192 

Method of Controlling Bleeding by Use of a Knotted 

Handkerchief Twisted by a Stick 222 

Method of Controlling Bleeding from the Leg below 

the Knee 222 

A Blanket Splint Applied to a Child's Thigh and Leg 244 



FOREWORD 

To fathers, mothers, and teachers, 
and, in fact, to every one interested 
even remotely in children, the critical 
question must recur again and again, 
" Shall we send for the doctor? " 

To answer this query in the simplest 
and most untechnical manner possible, 
and yet with sound scientific caution, 
this little book has been written. It is 
the result of both medical and psycho- 
logical experience gained in both gen- 
eral and clinic practice covering a num- 
ber of years. It is arranged and worded 
so that any person without technical 
training can quickly gain the requisite 
knowledge concerning the common ills 
and habits, physical and mental, of 
children. It is a book pre-eminently 
for parents, teachers, social workers, 
and all who work with children. 

The plan of the book is different 
from others in the same field. It cata- 



FOREWORD 

logues the simple, every-day, well- 
known ailments by their common 
names, and then describes the symp- 
toms of the harmless indispositions, 
tells how to treat them, and sharply 
marks them off from the serious dis- 
eases demanding a doctor's advice. The 
book tells when not to send for the doc- 
tor, exactly when to send for the doctor, 
and what to do in emergencies before 
the doctor comes. A carefully prepared 
index makes it immediately easy to look 
up any disease of a child. A number 
of the illustrations in the book are from 
original photographs. We are, how- 
ever, indebted for additional plates to 
Holmes' " Conservation of the Child," 
Willard's " Childhood Surgery," Cot- 
ton's " Diseases of Children," Davis' 
"Mother and Child" and Cooke's 
" Nurses' Handbook of Obstetrics." 

The Authors, 

Philadelphia, 1913. 



PART I 

SIMPLE NON-CONTAGIOUS AND CONTAGIOUS 
DISEASES 



CHAPTER I 

baby's cries 

"Shall we send for the doctor?" 
No one asks this question oftener than 
the mother with a young baby. The 
doctor has made his last call, the nurse 
has been dismissed, and the young 
mother is left alone to face the ordeal 
of baby's bath. If he accepts his ablu- 
tions with good humor, well and good. 
But suppose he cries? Suppose, in 
spite of all his anxious mother does, he 
keeps on crying? What does it pre- 
sage? And what do the other wails of 
the infant mean? Peevishness, hunger, 
discomfort, or disease? Who can tell 
but the doctor? With no one but her- 
self to hear her baby's cry — a hundred 
times a day, the mother " feels herself 
at sea." 

After the morning bath, a healthy 
baby should sleep for two hours or 

13 



WHEN TO SEND 

more, until his regular feeding time. 
If, instead, he is cross and fretful, the 
mother need not always take alarm. 
Let her make sure that there are no 
pins in his napkins, socks, bands, and 
shirts that are causing pain or even un- 
comfortable pressure upon his tender 
skin. Too many little buttons will be 
equally annoying to him. 

Sometimes the very ordeal of being 
dressed, especially if it be made a 
" fussy " one, frets a baby. To avoid 
this, it is an excellent plan to make his 
garments as few as possible. If a 
knitted woollen undershirt is worn, let 
it be one of extra length, in order that 
it may be used also as an abdominal 
band or binder. This provides for two 
garments in one. In addition there will 
be needed nothing more than a flannel 
petticoat and outside " slip " or dress. 
If these are both made with sleeves and 
with " skirts " of nearly the same 
length, the two may be slipped on 

14- 



FOR THE DOCTOR 

together over baby's head; should the 
knitted undervest and band be too 
costly, the undervest may be made of 
an inexpensive soft flannel like the pet- 
ticoat. In this event the three garments 
(undershirt, petticoat, and slip) may be 
put on all at one time, simplifying the 
morning toilet extremely, and disturb- 
ing baby's nerves far less than a more 
elaborate and needless supply of gar- 
ments will occasion. If buttons are 
used upon his clothes, let them be put 
on the front rather than on the back; 
this adds greatly to his comfort ; or, it is 
a good plan to substitute, for most of 
the buttons, narrow tape that may be 
easily tied. This may spare many of 
baby's cries. 

Cry of Hunger. 

" If baby cries after feeding time, 
what shall I do? " asks another mother. 
If this crying is attended with vigorous 
sucking of his fingers, and if it be a 

15 



WHEN TO SEND 

daily occurrence, he is hungry. Let the 
mother weigh the baby every day. 

Professor Rotch, of Harvard, says: 
" I count the systematic, daily weighing 
of infants during their first year more 
useful in determining their nutritive 
condition than any other method we 
have." The average daily gain during 
the first two months should be at least 
two-thirds of an ounce. The birth 
weight should be doubled at five months 
and trebled at fifteen months. 

Cry of Indigestion. 

If baby gains and loses in weight by 
turns, and feeding does not quiet him, 
but makes him cry the harder, he is suf- 
fering from indigestion. 

In this case, send for the doctor. 
Make no change in feeding till he is 
consulted. 

Cry of Colic. 

If the cry is a shrill shriek, attended 
with active kicking and struggling and 

16 



FOR THE DOCTOR 

drawing up of the legs and feet upon 
his belly, baby has colic. This is not 
serious. It can be relieved by wringing 
soft flannel dipped in hot water, and 
placing it upon the little abdomen. 
Sometimes a soft flannel bag filled with 
a mixture of ground cloves, cinnamon, 
ginger, and allspice, then steeped in 
boiling water and wrung out, may be 
used in the same way and will put the 
baby to dreaming peacefully. 

Cry of Earache. 

Piercing cries attended with much 
tossing of the baby's head from side to 
side, with a constant tendency to move- 
ments of the hands to the head, mean 
earache. Though this is not always se- 
rious, the doctor must be consulted. 
While waiting for him the ear-pain may 
be relieved by a tiny hot-water bottle 
placed over the ear. A flannel bag 
shaped like a glove-finger may be filled 

2 17 



WHEN TO SEND 

with heated salt and placed within the 
hollow of the ear. 

Cry of Temper and Habit. 

A loud, long cry, accompanied by 
" protest," or beating of the air with the 
fists, arms, feet, and legs, means tem- 
per. This must not be " coddled," lest 
it become the cry of habit that tries a 
mother's patience. The baby cries to 
be held, to be rocked, to be walked, or 
for anything by which it has been 
" spoiled." When the child gets what 
it wants, it ceases at once. 

This is the cry for which the filthy 
and pernicious "pacifier," or "mother's 
comforter," is used so often and so mis- 
takenly. We recognize it at once by its 
description as the nipple and ring — put 
into the child's mouth at the first whim- 
per of crying, falling to the floor or out 
of his carriage into the street, or into 
the dust and dirt wherever he may hap- 

18 



FOR THE DOCTOR 

pen to be, when he falls asleep. If he 
awakes crying, back into his mouth goes 
the " comforter " without thought of 
cleansing it, and thus much harm is 
done in every way. 

The Cry of Wasting Disease, 

A baby that seems healthy at birth 
and for the first few weeks may de- 
velop, at about the sixth week, a hoarse 
and ceaseless cry. If this continues all 
through the night and is attended by 
constant snuffling, the baby needs the 
doctor's most watchful care. 

The Cry of Rickets or Rhachitis. 

Sometimes between the sixth and fif- 
teenth months a baby will develop into 
a cross and restless child. If this is ac- 
companied by profuse sweating of the 
head, enough to wet the pillow and the 
baby's neck-bands, let the doctor know 
at once. This condition is a warning 
of rickets and must not be neglected. 

19 



WHEN TO SEND 



CHAPTER II 

COLDS 

" Colds" and Their Significance. 

In the case of children, exercise and 
fresh air are as necessary as proper 
feeding. They must not be confined 
within doors like hot-house plants. If 
acute illness or severe weather must 
keep them in the house, let the nursery 
or living-room be kept at an even tem- 
perature of 70 degrees Fahrenheit, and 
insist upon an abundance of pure air 
in such a room. 

Were these rules followed, " simple 
colds " among children would be less 
common. Proper clothing and cleanli- 
ness are likewise valuable in preventing 
constant colds. It is a mistake to dress 
children too heavily, or to cumber them 
with clothing in the house. It is better 
that they should be warmly but lightly 

so 



FOR THE DOCTOR 

dressed within doors, and that suffi- 
ciently heavy wraps or outer garments 
be provided for out-of-doors. It is not 
an exaggeration to say that we have 
seen children, in the early fall months 
of the year, " piled " or wrapped with 
heavy undervests, waists, and skirts, 
these being fastened or sewn together 
in order that they might not be removed 
until the arrival of spring! If this did 
nothing else, it makes thorough bodily 
cleanliness impossible. 

Daily bathing of the entire body, 
either by the sponging method or by 
the tub or basin, is necessary for good 
health. The skin, w r ith its pores scat- 
tered everywhere upon its surface, acts 
like a heat regulator and ventilator for 
the body. When the pores are blocked 
by gathered dust and dirt and sweat, 
the skin can no more do its work than 
can the chimney and " drafts " and 
" flues " of a kitchen stove that have 
21 



WHEN TO SEND 

become choked with ashes and dirt. 
Such a skin fails to protect the body 
from " taking cold." 

Simple Colds. 

How do we recognize a simple cold? 
It begins with slight chilliness or, at 
times, with a little feeling of fever or 
warmth. The head is hot, the cheeks 
may or may not be flushed; there is a 
discharge from the nose, at first thin 
and watery, later thick and ropy, 
blocking up the nostrils. When a child 
shows nothing more than these symp- 
toms, a teaspoonf ul of castor oil to open 
the bowels, and half a glass of hot lem- 
onade to aid the perspiration, are wise 
remedies. 

In place of the hot drink, a hot mus- 
tard foot-bath may be given. This is 
prepared by mixing four tablespoon- 
fuls of powdered mustard with a gallon 
of water made as hot as the skin of the 

22 



FOR THE DOCTOR 

elbow can bear. Simple diet without 
meats and sweets for two or three days, 
and abundant pure air day and night, 
in playroom and bedroom, with as much 
rest as possible, will all help to make 
the cold short lived. 

" Colds " a Sign of Rheumatism. 

Simple colds may occur at every tri- 
fling change of temperature, or even 
without apparent cause. Becoming 
thus habitual they pass into what we 
call chronic colds, and may be an evi- 
dence of an unsuspected and inherited 
rheumatic condition, or the presence of 
the much-talked-of " uric acid " in the 
blood. When a child does develop this 
tendency, the doctor's advice must be 
sought without further parley. 

" Colds " a Sign of Adenoids. 

On the other hand, these habitual 
colds may have a very different cause, 

23 



WHEN TO SEND 

and may arise from a condition of 
the nose and throat. Small or large, 
soft, spongy growths (called adenoids) 
behind *the nose, at the back of the 
throat, may commonly excite these 
" colds " one after another. A child 
so affected will show certain other signs 
of these growths. The blocking up of 
the nose will bring about a habit of 
mouth-breathing, and even loud snor- 
ing at night. The mouth is not only 
open, but the upper jaw is apt to " hang 
over " beyond the lower, crowding the 
teeth. Speech may be thick or even 
imperfect enough to make it difficult to 
understand. 

The presence of adenoids demands a 
surgical operation. Within six months 
after this is performed the " chronic 
colds " usually grow less frequent, and 
gradually, month by month, all the 
adenoid signs of face and jaw are less 

24 



FOR THE DOCTOR 

noticeable, the child ultimately out- 
growing them in many instances. 

A Cold often the Beginning of Measles. 

A cold may mean more than a com- 
mon or chronic affection. When it is 
so severe that the child sneezes hard and 
often, when his eyes weep continually — 
the tears running down his face, when 
he persistently avoids the light, and is 
stupid and drowsy all day, it means not 
a simple cold but an attack of measles. 

Every attack of measles needs the 
doctor, not for the disease alone, but for 
the evil effects which may follow. It is 
now understood that many instances of 
" adenoids " owe their beginning to an 
attack of measles. Moreover, many a 
victim of tuberculosis in later life may 
trace the origin of his fatal malady to 
the apparently harmless measles of his 
childhood. 

25 



WHEN TO SEND 

Colds a Sign of Influenza or Grippe. 

Grippe is claiming more victims 
among children within recent years. It 
also begins with a sudden heavy cold 
with the following peculiarities : An ex- 
tremely high fever, a hard dry cough, 
and an acute soreness and sensitiveness 
of the flesh all over the body. These 
symptoms demand the doctor without 
delay. 

Cold a Forerunner of Diphtheria. 

When a cold shows no other signs 
than a persistent discharge from the 
nose, and this discharge appears very 
suddenly in thick bloody shreds or is 
streaked with blood, it is a danger sig- 
nal of diphtheria. Lose no time here 
in sending for the doctor, 

Cold the Precursor of Croup. 

A child in all respects apparently 
well may contract cold by playing upon 

26 



FOR THE DOCTOR 

a cold floor ; at times a cold, damp bed- 
room, that has been scrubbed late in the 
afternoon and not thoroughly dried be- 
fore bedtime, will work the same mis- 
chief. The following day may find him 
with a slight discharge from the nose, 
but as bedtime comes near he may be a 
little hoarse or may develop during the 
evening a hollow barking cough. After 
a few hours of sleep he will awake 
acting as though he were choking. His 
breathing will be harsh and almost 
crowing; the barking cough of the early 
evening will be deeper and harder. He 
is frightened, and if he tries to cry or 
speak, no words come. 

Such an attack is one of false croup. 
Many children, particularly the weak 
and the rhachitic, seem predisposed 
thereto. It is a wise thing that the fam- 
ily medicine closet shall contain a two- 
ounce bottle of syrup of ipecac, that 
this remedy may be used to cut short a 

27 



WHEN TO SEND 

nightly invasion of false croup. Five 
drops of this, given every half -hour till 
vomiting is produced, will usually make 
the child comfortable for the remainder 
of the night. To prevent repetition of 
such an attack, the bowels must be regu- 
lated and the diet must be made simple. 
For a day or two the child should be 
kept in the house in a well-ventilated, 
evenly-heated, and, if possible, sunny 
room. Daily sponge-baths in warm 
\vater, with cold water sponging of neck 
and chest, are good preventives of fu- 
ture attacks ; but, if these measures fail, 
medical advice must be insisted upon to 
determine the possible cause of the 
condition. 

Cold the Precursor of Whooping Cough. * 

A prolonged obstinate cold may lead 
to a cough that also grows distressingly 
worse at the hour of bedtime. In such 
cases it is not unusual to find that every 

28 



FOR THE DOCTOR 

variety of cough mixture known has 
been given, but without great help. 
This is a mistake. The doctor must be 
consulted; if he discovers upon careful 
questioning that the cough has existed 
for ten to fifteen days and is even grow- 
ing harder, he will doubtless suspect 
whooping-cough. He will be right in 
insisting upon the fact that this disease 
cannot safely be regarded as a trivial 
one, because of possible fatal after ef- 
fects. Tuberculosis is very apt to de- 
velop as a result of whooping-cough; 
also certain serious nervous disorders 
may result therefrom, — i.e., epilepsy, 
paralysis, blindness, and deaf-mutism 
have all been known to occur in children 
with neglected and therefore prolonged 
illnesses from whooping-cough. 

Night Cough a Sign of Adenoids. 

A child with adenoids may develop a 
cough that, like the above, also grows 

29 



WHEN TO SEND 

worse at night. How shall the mother 
know that it means adenoids? Let her 
watch the child for any trace of mouth- 
breathing during the day, or his snoring 
at night, and a growing tendency to re- 
peated colds. In addition, he may de- 
velop the troublesome habit of bed- 
wetting at night, and may grow increas- 
ingly irritable and peevish, or else in- 
different and stupid. All these signs 
indicate adenoids, and, as we have ad- 
vised before, only a surgical operation 
for their removal offers any hope of 
relief and cure. 



30 



FOR THE DOCTOR 

CHAPTER III 

SORE THROAT 

Sore Throat Accompanying Adenoids. 

A child troubled with adenoids may 
awake, morning after morning, com- 
plaining of a dry sore throat. This 
arises from the irritation of the throat 
produced by the snoring and mouth- 
breathing of the night before. Mouth- 
breathing prevents the air from being 
sufficiently warm and moist to make 
it agreeable and unirritating to all 
the passage-way from the throat to the 
lungs. Proper breathing through the 
nose provides the needed heat and mois- 
ture that nature demands. The conse- 
quence, therefore, is that the mouth- 
breather, whether child or grow r n per- 
son, suffers habitually from dryness of 
all the air-passages. 

31 



WHEN TO SEND 

Simple Sore Throat. 

Cold, cough, and sore throat are apt 
either to accompany or follow one 
another in the ailments of early child- 
hood. 

If there is enough discharge from the 
nose to block up the passage, mouth- 
breathing will result, and we will have 
the dry, irritated sore throat described 
above. On the other hand, when a 
cough is present, if it is hard and dry, 
and frequent, it likewise results in an 
irritation of the lining of the throat. 

There is a soreness of the throat that 
means more than either of these, how- 
ever, — a soreness that makes swallow- 
ing a difficult, sometimes even a " tear- 
ful " matter. This condition is apt to 
be attended with slight or moderate 
feverishness. When a child complains 
of these " symptoms," look at his throat 
at once. If it shows only a very red 
surface, without spots (or ulcers) and 

32 




Examining child's throat, with tablespoon holding down the tongue. 



FOR THE DOCTOR 

patches (or membrane), it is not neces- 
sarily serious. Under these circum- 
stances let the child be given a teaspoon- 
ful of Husband's magnesia or milk of 
magnesia to open the bowels; at the 
same time let the throat be gargled or 
rinsed with a simple mixture of per- 
oxide of hydrogen and lime water in 
equal proportions. 

Sore Throat a Sign of Scarlet Fever. 

When a sore throat is attended with 
painful swallowing, with high fever and 
vomiting, and possibly a convulsion, 
send at once for the doctor. These 
signs presage scarlet fever. 

Sore Throat a Sign of Diphtheria. 

Every complaint of sore throat must 
be heeded. Even a slight soreness, 
without high fever or painful swallow- 
ing, may reveal, to the mother's sur- 
prise, a gray- white " film " upon either 
tonsil or on the soft palate. If at the 

3 33 



WHEN TO SEND 

same time the glands of the neck behind 
the jaw are swollen and painful, these 
are danger signals of diphtheria. Lose 
no time in sending for the doctor in such 
a case. 

Simple Tonsillitis. 

When, instead of the gray film de- 
scribed above, the tonsils are studded 
over with numerous yellow spots, pin- 
head in size, we have a simple tonsillitis. 
This needs the doctor's care, for such 
attacks point to rheumatic infection, 
which must not be neglected. 

Quinsy. 

When sore throat is accompanied by 
a husky voice and a complaint that 
swallowing is painful, an attack of 
quinsy is to be feared. An inspection 
of the throat will find one or both ton- 
sils very red and very large; in truth, 
large enough at times to make it quite 

34 



FOR THE DOCTOR 

impossible to open the mouth. More- 
over, this form of sore throat is usually 
attended with decided fever and chills, 
due to the fact that pus is forming 
within the substance of the tonsils, and 
must be given a way of escape before 
the conditions improve. The lancing 
of the tonsillar abscesses is the only 
speedy or sure cure for an attack of 
quinsy. 



35 



WHEN TO SEND 



CHAPTER IV 

FEVERS 

Fever. 

Many of the diseases of children are 
attended with fever. In infants and 
the very young, fever will take a higher 
course than from a similar cause in 
later life. Very high fever, therefore, 
is not always a serious matter ; there are 
times when, after a doctor's careful ex- 
amination of the child, high fever of- 
fers no explanation. 

The mother, or care-taker, in estimat- 
ing fever, must not trust to her sense 
of touch alone, because it is unreliable. 
Let her learn to " read " the clinical 
thermometer, purchasable for a small 
sum at any drug or department store. 

This small apparatus consists of a 
sealed glass tube with about an inch- 
length bulb of mercury at its lower end. 




Position of infant for introduction of thermometer. 



FOR THE DOCTOR 

The remainder of the tube contains a 
white porcelain scale marked off and 
numbered in degrees (these and the 
numbers are in heavy black, for easy 
reading). The scale extends usually 
from 90° to 110°, in intervals of 
fifths,— thus, 90°, 95°, 100°, 110°. At 
the point on the scale marking 98 4/5°, 
a tiny black arrow signifies this to be 
the temperature for ordinary or " nor- 
mal " health. 

The thermometer ready for use will 
show the mercury in the bulb to have 
expanded or " run up " into a thread- 
like silver line to about 95°. To use it, 
place the instrument under the tongue 
of the " patient," letting the lips hold 
it tightly for two minutes. In a baby 
it is best and most safely held in the 
opening of the rectum, or lower bowel, 
for one minute. 

When the temperature is normal, — 

37 



WHEN TO SEND 

i.e., no fever, — the thread-like column 
of mercury will have risen to the point 
on the scale marked by the arrow, 
98 4/5°. When the column of mercury 
rises to any interval on the scale be- 
tween 100° and 101°, the child is said 
to have slight fever; to any interval be- 
tween 101° and 103°, moderate fever; 
to any interval between 103° and 105°, 
high fever. 

Upon withdrawing the thermometer, 
shake it briskly till the mercury falls to 
the point marked at 95°. Wash it 
carefully in clean cold water. It must 
be washed before and after each using. 

If for any reason whatever a ther- 
mometer is not obtainable, how is the 
mother to judge whether the child's 
condition is serious or not ? If he comes 
running into the house red-cheeked and 
out of breath, shall she be alarmed? 
Not necessarily, because the flushed 

38 



FOR THE DOCTOR 

face and forehead at such a time are 
probably wet or damp with perspira- 
tion. This child is overheated from ex- 
ercise, not really feverish. 

Should such a child show after violent 
exercise a face so flushed that it assumes 
a purplish blue, and the shortness of 
breath be painful, it is possible that he 
is overtaxing his heart. Let the mother 
have a watchful care for this, calling 
the doctor's notice to it if it occurs often. 

In real fever the red cheeks and fore- 
head, instead of being covered with per- 
spiration, are burning and dry; the 
hands are hot to the touch; in a baby 
there are great thirst and restlessness 
under these conditions ; in an older child 
there are peevishness, or great indiffer- 
ence, sudden dislike of food, thirst, and 
perhaps headache. 

If the mother has been hard at work, 
cooking, or doing any task that has con- 



WHEN TO SEND 

fined her near the stove or range, it will 
be difficult for her to detect the true 
measure of the child's hot cheeks. 
Therefore, at such a time, the little fever 
thermometer is the only safe guide for 
her. 

Fever in Stomach and Bowel Troubles. 

In a child sudden high fever occurs 
often with mild attacks of indigestion. 
Unripe fruit, candy or pastry to which 
he may be unaccustomed, strawberries, 
tomatoes, or vegetables of too coarse a 
fibre, — any of these undigested and un- 
dissolved in the stomach will cause vom- 
iting, diarrhoea, thirst, and loss of appe- 
tite. Fever is present invariably under 
these conditions. 

Such attacks are not serious. As 
soon as the vomiting and purging re- 
lieve the stomach and bowels of the of- 
fending material, the temperature will 
fall, — i.e., become normal. 

40 



FOR THE DOCTOR 

Fever and Delirium. 

Moderate temperatures, from 101° to 
103°, in children are accompanied by 
more nervous excitement than the same 
amount of fever will arouse in adult 
life. 

The mother need not be alarmed if a 
child with such a degree of fever be- 
comes slightly delirious by day or rest- 
less by night. Such condition can be 
relieved speedily by the sponging of 
the child's body (a portion of it at a 
time) with cool water at a temperature 
from 80° to 85°, or with a mixture of 
equal parts of vinegar and water. 

Fever and Sore Throat. 

Fever and chilliness " by turn," with 
backache and headache, forewarn the 
mother of impending tonsillitis in a 
child, sometimes fully twenty-four 
hours before there is anything seen in 
the throat. It will never come amiss, 

41 



WHEN TO SEND 

under these conditions, to see that the 
bowels are opened freely and the child 
kept within doors in a temperate and 
well-ventilated room. Of the first sign 
of yellowish " spots " in the throat the 
doctor must be advised at once. 

Fever a Premonitory Sign of Scarlatina, 

A child developing scarlet fever may 
show exactly the symptoms described 
above, but with the difference that the 
fever is higher (104° or 105°) and that 
it is accompanied by vomiting or a con- 
vulsion. Even though there be no spots 
seen within the throat, with these symp- 
toms present, send for the doctor at 
once. 

Fever in Middle=ear Disease. 

Fever in children for which no cause 
can be found may signify inflammation 
of the middle ear, that portion con- 
cealed beyond the little " drum-head.'' 

42 



FOR THE DOCTOR 

The trouble is unsuspected oftenest in 
infancy, because the delicate tissues of 
the middle ear, not being as firm as in 
older children, yield more readily to 
swelling, thus causing little or no warn- 
ing pain. 

Even in older children a seemingly 
trifling inflammation of the middle ear 
may be neglected. This is a serious 
and sometimes deadly mistake. Fever 
and earache existing together must have 
the doctor's attention at once. If the 
summoning of medical aid be delayed 
until discharge or suppuration appear, 
infection may be spreading from the 
middle to the inner ear, a most alarming 
condition. 

Fever a Warning of Pneumonia. 

Fever of 104° or even higher, with a 
decided chill or a convulsion, with rapid 
breathing, requires the doctor at once. 

43 



WHEN TO SEND 

These symptoms associated mean pneu- 
monia, in which delays are always 
dangerous. 

Fever in Typhoid, Tuberculosis, and Malaria. 

If, in spite of attention to the bowels 
and the diet, fever of moderate degree 
persists for two or three days, send for 
the doctor without further delay. 

Typhoid fever, tuberculosis, and the 
several types of malarial fever, all show 
similar signs, at their onset, and only 
the physician is competent to be judge 
and guide in the reading of such signs. 



tt 



FOR THE DOCTOR 

CHAPTER V 

THE SICK STOMACH 

Vomiting. 

Attacks of " indigestion " or vomit- 
ing are common from infancy through- 
out all childhood's stages. What do 
they signify? 

They may be nothing but the result 
of overeating. If so, one or two days 
of complete rest of the stomach will act 
like magic in the restoration to health. 

Should dieting not cure the attack, 
is it wise to depend on the corner drug- 
store for the every-day pepsin and the 
harmless soda mint? No, because re- 
peated attacks of vomiting mean some- 
thing more than merely an upset stom- 
ach, which only the doctor can decide. 

Vomiting in Eyestrain. 

Many a child that has been troubled 
for months, or even years, with vomit- 

45 



WHEN TO SEND 

ing day after day, appearing at some 
time during the morning session of 
school, finds the condition cured, as 
though it has been " charmed " away, 
by the time he has worn his new glasses 
for a month. Repeated headaches, 
frowning lines between his eyes, and 
scowling forehead must warn every 
mother that such signs need the oculist's 
inspection. 

Vomiting Associated with Worms. 

When vomiting is attended with a 
loss of appetite, a foul odor to the 
breath, and such nervous symptoms as 
picking the nose, and grinding the teeth 
by day or night, worms may be sus- 
pected. Such suspicion must be re- 
ported at once to the doctor. 

Vomiting in the beginning of Tuberculosis. 

Many a child with vomiting is 
" dosed " by the mother or nurse for 
worms, when the cause of the trouble is 

46 



FOR THE DOCTOR 

far more serious. Chronic indigestion, 
oftener than suspected, is a sign of an 
early stage of tuberculosis in children. 
There may be at the same time little 
or no fever and no alarming cough. So 
treacherous is this disease that repeated 
vomiting in a child not robust should 
have the doctor's careful consideration. 

Vomiting in Intestinal Obstruction. 

When sudden severe vomiting is ac- 
companied by constipation of the 
bowels, with pain and soreness all over 
the belly, it is due to some obstruction 
in the large or small bowel. With such 
attacks there may be fever; quite as 
often, instead of fever there may be so 
much chilliness as to make the hands 
and fingers shrivelled and blue. Lose 
no time here in sending for the doctor. 

Acute Vomiting in Typhoid Fever. 

Instead of the constipation that char- 
acterizes the earliest week of typhoid 

47 



WHEN TO SEND 

'fever in adult life, this disease may 
make its appearance in children with 
attacks of vomiting. These will be as- 
sociated with fever that has persisted 
without change for two or three days, 
with dull listlessness of the mind and 
sluggishness of the body. The doctor 
must be called at once. 

Acute Vomiting in Scarlet Fever. 

We have described heretofore the 
vomiting that ushers in scarlet fever 
habitually. 

Acute Vomiting in Meningitis. 

In tumors of the brain and in acute 
meningitis, acute sudden vomiting is 
a dreaded sign. It comes with such 
force that it is called " projectile," as 
though the contents of the stomach were 
shot from a cannon's mouth. This 
needs the doctor without delay. 

This is one of the horrible accompani- 

48 



FOR THE DOCTOR 

ments of the neglected ear disease de- 
scribed above. It is not a long route 
from the inner ear to the brain; when 
suppuration in the deepest portions of 
the inner ear is not checked, it takes 
this route, and a child may die from 
meningitis in which the ear disease was 
unsuspected or neglected. 



48 



WHEN TO SEND 



CHAPTER VI 

BOWEL TROUBLES 

Diarrhoea. 

Like vomiting, diarrhoea is in itself 
but a symptom, not a disease. It is, 
moreover, a symptom to which children 
are particularly prone. 

Acute. 

It may be acute and brief in duration. 
In infants such a thing as a sudden 
change in the day's temperature will 
provoke an attack. In older children a 
sudden fright, a sudden unexpected 
pleasure, or a dreaded ordeal in school 
may excite it. 

Chronic. 

It may be chronic — as such, not al- 
ways long in duration, but attacking a 
child frequently. When this is the case, 

50 



FOR THE DOCTOR 

diarrhoea may be a warning of maras- 
mus, of rickets, or of tuberculosis, all 
of these being diseases of disturbed nu- 
trition. Because of these facts, e very- 
attack of diarrhoea must be reported to 
the doctor. 

In making such report, the mother 
or nurse must count the number of pas- 
sages, or stools. She must describe 
their color, whether they be brown or 
greenish or yellowish. She must de- 
scribe their nature, whether they are 
simply unusually soft passages, or 
watery, whether they are composed 
largely of mucus, or if they contain 
blood. 

She must watch to see if the passage 
be one of easy movement or if it be at- 
tended with straining. Without all of 
these facts reported, the doctor will be 
at some loss in his careful accounting 
for the cause of any amount of 
diarrhoea. 

51 



WHEN TO SEND 

Further than making such report, it 
is not safe for the mother or nurse to 
go. The condition is never one to be 
dismissed as a trivial one. 

Constipation. 

When the bowel passages are hard, 
dry, difficult, and infrequent, they are 
" constipated." 

The daily, healthful " evacuation," or 
movements of the bowels, can be in part 
controlled by the diet. Enough food, 
and that of the right kind, must be eaten 
to produce sufficient quantity or bulk 
of waste matter, to persuade the bowel 
itself to work. Moreover, the mother or 
nurse must begin in the first months of 
infancy to form a fixed habit of empty- 
ing the bowel, by placing the child on 
the chamber, or chair, daily at an un- 
varying hour. The bowel can be taught 
thus to do its proper duty. 

As in diarrhoea, the mother must be 

52 



FOR THE DOCTOR 

watchful enough to report to the doctor 
the appearance of constipated stools. 
She must observe if they be dark in 
color, or gray-white, or putty-hued, or 
streaked with blood. She must report 
whether they be long, as though 
" moulded " from the bowel, or flat 
and ribbon-like, or in small ball-like 
masses. 

When constipation exists in a child, 
if a piece of white castile soap, shaped 
into a small cone an inch in length, held 
in the bowel for a few minutes produces 
a movement, the mother can report to 
the doctor that only the lower bowel 
seems at fault. When this does not 
produce an evacuation, and the delayed 
stool is gray white and of bad odor, the 
small intestine is at fault. 

In older children constipation is 
largely a matter of wrong diet, or of 
poor teeth and, therefore, insufficiently 
masticated food, or of lack of exercise, 

53 



WHEN TO SEND 

and neglect of attention to a regular 
time for emptying the bowel. 

What are the results of constipation? 
The chronic " bad breath " of children, 
the pale face, the cold hands and feet, 
the distended belly, are frequent and 
familiar. Irritability and peevishness, 
on the one hand, or dull listlessness of 
mind, on the other, may betoken con- 
stipation so long standing that it may 
result in slow poisoning of the en- 
tire system. Many headaches not due 
to eye-strain may arise from constipa- 
tion. The condition, therefore, is one 
that demands a doctor's wise direction, 
in place of the frequent " dosing " at 
home. 



64 



FOR THE DOCTOR 

CHAPTER VII 

HEADACHE 

Headache from Constipation. 

Among very young children, head- 
ache is not a frequent occurrence. 
When it does exist, it is not apt to be 
" an attack of nerves/' as in their elders, 
but is a result of unsuspected or even 
neglected conditions of surroundings, 
or of some physical defect, as of eyes 
or nose. 

We have already hinted at the head- 
ache arising from constipation. In this 
instance a child will complain of pain 
in the front of the head just above the 
eyes, which is made worse by sudden 
movements of the head. It appears in 
company with a coated tongue and 
" bad breath." In girls given to the 
habit, not uncommonly the face is 

55 



WHEN TO SEND 

" broken out," — i.e., covered with pim- 
ples of acne, a common skin disease. 
The latter condition is the one that will 
make a girl willing to see the doctor, 
though the constipation and headache 
may have been neglected with stolid 
indifference. 

Headache from Poor Ventilation. 

Many older children suffer from 
headache caused by breathing stale air 
in un ventilated rooms by day and night. 
Such air is lacking in the oxygen that 
the blood of the body needs for its puri- 
fication, and the part of the body first 
to feel the effect of this lack is the brain. 
Headache arising from such a cause is 
associated with pale face, dull eyes, per- 
sistent yawning, and disinclination for 
work at home or in school. 

It ought not to be necessary that the 
doctor is the first to find the cause for 
these headaches, because fresh air is 
within the reach of all. A room need 

56 



FOR THE DOCTOR 

not be " stuffy " to be warm. To be 
healthful, its temperature must range 
from 68° to 70° Fahrenheit, and it 
must be regulated by the heating ap- 
paratus of the house or of the room, 
not by the closing of doors and win- 
dows, thus excluding the air of " all 
out-doors." 

Headache from Adenoids and any Form of 
Nasal Obstruction. 

Precisely as the lack of oxygen in 
the blood from causes outside of the 
body operates in producing headache, 
causes within the body will result in the 
same disturbance. 

When adenoids, or persistent catarrh 
of the nose, block the way to the free 
passage of air to and from the lungs, 
again we find the blood suffering from 
a want of oxygen, and again will the 
brain be the first to " cry out " its 
grievance. 

Headaches arising from adenoids oc- 

57 



WHEN TO SEND 

cur at the " root " of the nose, and are 
made worse by coughing, or by the 
bending of the head. They are asso- 
ciated with " chronic colds " (which 
see) and the habit of mouth-breathing. 
A child suffering from these symptoms 
is seen to have a thick nose with a broad 
bridge, a short upper lip and persis- 
tently open mouth, and irregular, mis- 
placed, crowded teeth. 

Nothing short of a surgical operation 
is to be advised under these circum- 
stances. It will be followed usually by 
great relief from headache and " colds." 

Headache from Eye=strain. 

Headaches from eye-strain occur 
either in the front or the back of the 
head. They appear regularly after the 
eyes have been used for any work, as 
reading or sewing. They are accom- 
panied, frequently, by " sick " stomach 
and vomiting. 

58 



FOR THE DOCTOR 

Should the eye-strain be unsuspected, 
other circumstances ought to put one 
on the " right scent " for the condition, 
such as, for instance, curious habits of 
holding a book when reading, difficulty 
in threading needles, or a wrinkled fore- 
head, twisted neck, and stooped shoul- 
ders. Headaches associated with these 
symptoms need a specialist's care, for 
here and now, above all other times, 
delays are dangerous. 

Headache of Anaemia. 

Headaches are not uncommon in 
girls from ten to fourteen years of age 
who are being " pushed " at school, 
" skipping " grades, reaching high per- 
centages. They come with a sore, 
pressing pain in the forehead or on the 
top and back of the head. They are 
attended by loss of appetite, loss of 
sleep, and sometimes a habit of nervous 
twitching. These betoken " anaemia," 

59 



WHEN TO SEND 

or impoverished blood, for which the 
physician must be consulted immedi- 
ately. Any delay in seeking medical 
aid may result in permanent physical 
and mental breakdown. 

Pallor of Anaemia. 

The headache of an ansemic girl is 
usually accompanied with a pale and 
puffy face, this proving the condition 
of the blood beyond doubt; the mem- 
brane of the lips, the eyelids, the gums, 
and the finger-nails will likewise be so 
pale at times as to show absolute loss of 
color. 

Such a child tires easily, grows 
" winded," is short of breath after slight 
exertion. A brisk run out-of-doors may 
bring her home showing cheeks slightly 
pink, but this improvement is short- 
lived, and after half an hour in the house 
she is colorless again. 

A continuous pallor like this requires 

60 



FOR THE DOCTOR 

the doctor's attention, for there are 
deep-lying causes of anaemia, — i.e., fa- 
tigue, tuberculosis, kidney disease, heart 
disease — that can be determined only 
by the physician. 

Pallor in the Underfed Child. 

The pallor of anaemia is waxy in its 
hue. We see in every schoolroom, how- 
ever, the pale and sallow child, the re- 
sult of underfeeding. This child is 
usually below standard weight and is 
nervous and restless. 

For such as these the experiment of 
the school lunch is in progress to-day in 
the crowded districts of our large cities. 
Careful records of such children, taken 
at the beginning and end of their school 
term, show individual gains in weight, 
with uniformly better health. Pale 
cheeks grow rosy, almost plump, and 
spirits grow contented. 



61 



WHEN TO SEND 



CHAPTER VIII 

SKIN ERUPTION 

Skin Eruptions. 

We have not only the problem of 
the pale-faced child, but that of the face 
(and skin, in general) that is " broken 
out." The number of skin eruptions is 
legion, whether they be pimples or 
" papules," patches or " crusts," blis- 
ters, boils, or rashes. 

Less than one hundred years ago all 
skin diseases were supposed to be of 
constitutional origin, or to arise, as said 
commonly, " from the blood." Many 
of them were called " humors of the 
blood"! To-day we know that many 
of the commonest skin eruptions are due 
to germs or parasites that thrive easily 
because skins are neglected or are posi- 
tively unclean. Such eruptions are con- 

62 



FOR THE DOCTOR 

tagious, and children suffering there- 
from must be excluded from school un- 
til they are pronounced " cured," either 
by the school or family doctor or the ex- 
tra-vigilant school nurse. 

Likewise the non-contagious skin 
diseases require medical care. The doc- 
tor must be called upon to determine 
the true cause of a skin eruption of this 
nature. The cheap and poor soaps, the 
freely advertised salves or ointments, 
washes or lotions, that are applied often 
without the doctor's advice, but serve 
to aggravate and irritate, rather than 
cure, an already troublesome eruption. 

How to Distinguish Eczemas. 

In the case of the school child, is it 
possible for the mother or the teacher 
to decide whether an eruption be con- 
tagious or not? For instance, a long- 
standing eczema may be due to im- 
proper diet or to chronic constipation 

63 



WHEN TO SEND 

or it may be associated with rheumatism 
and gout. On the other hand, eczema 
may be due to the irritation caused by 
head-lice, in which case it is communi- 
cable. In both cases the eruption is 
similar. There will be the small red 
pimples or " papules " that tend to 
" run together " or coalesce. These be- 
come moist or " weeping," and continue 
so for a short time. Later these moist 
patches grow partially dry and appear 
as dirty-brown crusts. Intense itching 
is present always, and the consequent 
scratching of the skin produces new 
pimples, more weeping, more crusts. 

When the eczema arises from the ir- 
ritation produced by head-lice, the eggs 
or " nits " can be found in the head. 
They are very small, silvery white in 
color, and stick persistently to the in- 
dividual hairs, being immovable even 
with vigorous brushing. 

64 



FOR THE DOCTOR 

How to Distinguish between Eczema and Itch. 

Again, it is sometimes difficult to 
distinguish an attack of eczema from 
" the itch," the latter being one of the 
most contagious of all skin diseases. It 
is more frequent among the school chil- 
dren recruited from the ranks of the 
poor, the crowded and the immigrant 
population. It is caused by the bur- 
rowing into and under the skin of the 
itch-mite, which small parasite prefers 
certain parts of the body to others, not- 
ably the palms, the webs of the fingers, 
the wrists, ankles, spaces between the 
toes, the soles of the feet, the armpits, 
and the buttocks. 

The intense irritation produced by 
the mite gives rise to the inflamed 
pimples that may unite into small 
groups like the weeping papules of ec- 
zema. How is it possible to distinguish 
between the two? 

5 65 



WHEN TO SEND 

Upon close inspection, scabies can be 
recognized, beyond all doubt, by the 
small brown-black " zigzag " line or 
furrow (from an eighth to a half inch 
in length), — the "track" of the itch- 
mite. Furthermore, there will no doubt 
be found more than one member of the 
family suffering from the disease. It 
is needless to say that constant medical 
treatment is the only means of cure for 
this contagious skin affection. 

How to Distinguish Eczema of the Scalp from 
Ringworm of the Scalp. 

To the inexperienced care-taker 
some confusion may result from a slight 
resemblance between eczema of the 
scalp and ringworm of the scalp. The 
latter begins as a small pimple around 
a hair, but grows into a circular patch. 
The spreading takes place at the outer 
border or " circumference " to such an 
extent that the patch may be two inches 

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FOR THE DOCTOR 

in diameter. Several rings occur close 
to each other. The hairs within the 
patch become brittle and break, leav- 
ing " stumps " of broken hair pointing 
in all directions. As these stumps fall 
out, there will be bald patches all over 
the scalp. 

In eczema of the scalp there are the 
beginning papules with many circular 
crusts. After these fall away, however, 
we find neither the separate ring-like 
patches of baldness nor the broken hair 
stumps. In either condition, whether 
eczema or ringworm, faithful and per- 
sistent medical care is demanded 
absolutely. 

How to Distinguish between Ringworm of the 
Scalp and Favus. 

Another contagious scalp disease, 
known as favus, bears a resemblance to 
ringworm. In truth, it is known other- 
wise as " crusted ringworm." Here, 

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WHEN TO SEND 

however, instead of the scaly patches 
increasing at the circumference, they 
" heap " or pile upon each other, form- 
ing deep cups of sulphur-yellow color. 
If medical advice is not followed 
strictly, these cups will cover the en- 
tire scalp in disgusting moist masses. 
Because these destroy entirely the roots 
of the hairs, permanent baldness is a 
frequent result of favus. 

Nettle=rash. 

Of the non-contagious skin erup- 
tions, one, that puzzles the doctor quite 
as often as the mother, is nettle-rash, 
or " urticaria." It occurs often, among 
children, in the form of inflamed red 
pimples, the tops of which become cov- 
ered with thin crusts or " scabs." They 
itch severely, and, upon scratching the 
skin, those portions that are not 
" broken out " into pimples " swell up " 
into pink spots, or " splotches," called 

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FOR THE DOCTOR 

" wheals." If scratching is controlled, 
these pink wheals fade and disappear, 
sometimes as suddenly as they came. 

Nettle-rash, called also " hives," may 
be the result of indigestion. The eat- 
ing of certain articles of food — i.e., oat- 
meal, buckwheat, pork, strawberries — 
is followed invariably, in some children, 
by a sudden attack of " hives." 

In other children an eruption of 
" hives " is caused by certain drugs, 
such as quinine, belladonna, and anti- 
pyrine. 

Because of these facts, no outbreak 
of urticaria is to be regarded carelessly. 
The investigation of its cause, as well 
as the directions for its treatment, must 
be the duty of the physician. 

Scaling of the Skin, 

" Scaling " of the skin is a condition 
that will often bring a question from 
the mother. There is one form of ec- 



WHEN TO SEND 

zema that is accompanied by a constant 
tendency to " scale," instead of exhibit- 
ing the usual pimples and ugly 
pustules. 

The scales of this form of the disease 
are a dirty yellow in color. They are 
found usually at the back of the neck, 
where possibly the first outbreak of the 
eruption may have been caused by the 
rubbing of a neck band or of a collar; 
or they are found upon the outermost 
side of the legs and arms, — at the line 
of the top of the shoe, for instance, — 
or near the elbow. The scales are ac- 
companied by a persistent uncontrol- 
lable itching, and, though they seem 
perfectly dry, if they are scratched or 
rubbed, there comes a decided moist 
oozing upon the skin where the scales 
are rubbed away. This is the so-called 
" wet- tetter " of the days of our fore- 
bears. Of course, such a condition 
needs the doctor's advice, instead of the 

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FOR THE DOCTOR 

home experiments with endless salves 
and " washes " and impure soaps. In 
addition there will be doubtless the un- 
derlying cause of a rheumatic tendency 
or rhachitis or " scrofula/' which the 
physician must at the same time take 
into consideration in his treatment of 
the eruption. 

Scaling after Fever. 

In ordinary severe scarlet-fever, at 
the end of the first week of the disease, 
there begins the well-marked scaling 
peculiar to this condition. Wherever 
the eruption appeared this scaling 
takes place. From the hands and feet 
it is so complete and thorough — this 
shedding of the skin — that it appears 
as though almost perfect moulds or 
casts fell away; in the hands this scal- 
ing comes often as a glove-finger 
might roll off. From the feet almost 
stocking-like moulds are seen. 

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WHEN TO SEND 

In very mild attacks the scaling will 
be less pronounced, although it exists. 
Here it will be discovered in thin 
" plaques," or large flakes of dry skin, 
or in long strips. It may occur over 
and over again while a child is conva- 
lescing, so that he finds a never-ending 
fund of curiosity in pulling off these 
strips and patches of " old clothes," as 
it were. Even in the mildest form of 
scarlet fever it is present. We know of 
children who were allowed to attend 
school throughout a light attack of the 
disease, in whom the condition had 
never been discovered, had not a sharp- 
sighted teacher found slight scaling 
near the child's elbow- joint. 

Again the eruption of scarlet fever 
may be so indistinct as to show a half- 
way resemblance to that of measles. If 
in the course of ten days or two weeks 
there follows an unexplainable attack 
of rheumatism, or an attack of dropsy, 

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FOR THE DOCTOR 

or a foul and " running " ear, let the 
mother or nurse look carefully for some 
traces of scaling or peeling. It will 
doubtless be found, and the nature of 
the attack will be at once made clear. 
It is worth while just here to make 
the statement that as long as such peel- 
ing or scaling persists, scarlet fever re- 
mains actively contagious. Moreover, 
these facts explain why the contagion 
of scarlet fever is so lasting, — why it 
may be transmitted after the lapse of 
years, in fact. More than once, dresses 
or underwear have been stored or 
packed in drawers, chests, or trunks 
without thorough fumigation after an 
attack of scarlet fever, and the germs 
or microbes have remained in the small 
flakes or particles of skin adhering to 
these garments. Carpets, rugs, bed- 
ding, and floors upon which the scales 
have fallen a-nd adhered are likewise 

73 



WHEN TO SEND 

active avenues of contagion unless they 
are thoroughly steamed or fumigated. 

Scaling in Measles. 

When the eruption in measles is es- 
pecially pronounced, there may follow 
a slight amount of scaling, but it will 
not appear as strips or flakes or patches 
or " moulds " as in scarlet fever. In- 
stead it will resemble more closely what 
one observer described as " fine branny 
dust." This soon disappears entirely. 

Scaling from the Scalp. 

Among children we find an occa- 
sional scaling from the scalp known or- 
dinarily as " dandruff." When it ex- 
ists, the scales are usually small, most 
of them pin-head in size, sometimes tri- 
flingly larger; they are gray- white in 
color and are flat. Sometimes dandruff 
may be so profuse as to be a dry pow- 
dery mass through the hair, instead of 

74 



FOR THE DOCTOR 

distinctly scaly. If abundant, it is apt 
to cause itching. In that case there will 
be a disagreeable suspicion of its be- 
ing far worse than dandruff. How is 
it possible to distinguish between the 
smallest scales of dandruff and the dis- 
gusting nits of head-lice? By one sim- 
ple distinction, — namely, the dandruff 
scales can be removed from the hair and 
the scalp by vigorous brushing, whereas 
the nits hold fast to the individual 
hairs, sticking " closer than a brother " ! 

What is Dandruff? 

Dandruff is a collection of scales of 
dead skin from the scalp and the natu- 
ral oily or fatty matter of the hair. 
Ordinarily, if the skin of the scalp is 
kept clean and the hair is kept well 
aired and well brushed (not severely 
brushed), these scales do not accumu- 
late. If there is a constant tendency 
for such a thing to occur, in spite of 

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WHEN TO SEND 

scrupulous cleanliness, then the doctor 
or " skin specialist " must be consulted. 

Boils. 

A common source of infection of the 
skin among children is that of the 
" boil." In former times we talked of 
a " crop of boils " and looked upon 
them as proof that for some reason 
" the blood was out of order." Because 
of this belief, doses of " spring medi- 
cine " were given and taken annually 
to forestall the invasion of a year's new 
crop. 

To-day we know that the boil is 
caused by the entrance of a germ into 
the skin. This takes place first in the 
skin surrounding one of the " follicles," 
or tubes of a hair, in any part of the 
body. The first sign of the unwelcome 
intruder will be a slight tingling or 
itching of the skin; next appears a red 
pimple raised above the surface and 
sensitive to the touch. The skin sur- 

76 



Fio 9, A 

PiaPricK ^==^ Cuticle 



Fio. 9, B 




Sweat 
Gland 



Xiffe' 



A shows structure of healthy skin B shows germs resulting from, injury. 
before irritated by pin prick or 
entrance of "dirt" germs of any 
nature. 



Fio. 9. C 




Fig. 9, D 




C shows the growth of "core' 
a boil. 



of D shows core changed to pus or 

matter draining through first site of 
old pin prick. 



FOR THE DOCTOR 

rounding this grows hard, swollen, and 
bright, rather fiery red, while the boil 
itself — i.e., the original pimple — be- 
comes duller in color. The pain is now 
throbbing instead of tingling, showing 
' pus " is forming, and, because it is 
confined within a small space, is mak- 
ing pressure all around upon the small 
and delicate nerves of the skin. 

The best and proper thing to do is 
to allow the doctor to " lance " the boil 
at the first sign of pus. This will make 
it possible for him to dislodge the so- 
called " core," which is a greenish-yel- 
low mass of matter at the centre of the 
boil, extending down into the deeper 
skin. It is almost impossible to de- 
scribe the relief of pain and swelling 
that follows this method of procedure. 

If, however, according to old-time 
ideas, the boil be poulticed till it is 
thought " ripe " for lancing, as it grows 
larger and softer so will infection 
spread deeper, and there will be not 

77 



WHEN TO SEND 

only the familiar " crop of boils/' but 
a possible undermining of the general 
health. This will arise from the loss 
of appetite, of flesh, and of sleep 
that continued pain and suppuration 
produce. 

The germ that causes the first irri- 
tation within the hair-sac may be car- 
ried by the finger-nail that is not kept 
carefully cleaned. An eruption of ec- 
zema, that causes intense itching, or 
head-lice, in fact, anything that brings 
about the constant scratching of the 
skin, is very frequently followed by a 
crop of boils. 

Skins that are kept clean by a thor- 
ough daily application of soap and hot 
water, and nails and hair that are kept 
clean, are all a good " insurance " and 
safeguard against most of the non-fe- 
brile skin eruptions. If cleanliness is 
next to godliness, it must come before 
good health. 

78 



FOR THE DOCTOR 

CHAPTER IX 

CONTAGIOUS FEBRILE DISEASES 

Acute Epidemic Infectious Diseases with Skin 
Eruptions or " Rashes." 

Certain diseases that are highly con- 
tagious occur as " epidemics " and are 
characterized by eruptions of the skin. 
Why are they classed as infectious and 
epidemic? 

An infectious disease is one that is 
caused by the entrance and growth, or 
" multiplication/' within the body of 
" micro-organisms/' — ix., small bodies 
or " germs/' These grow rapidly, and 
accomplish, at one and the same time, 
two things, — (1) the making of a 
"virus" or poison, and (2) the de- 
struction of the tissues of the larger 
body within which they grow. 

Such destruction is seen in the film 

79 



WHEN TO SEND 

or patch on the tonsils in diphtheria, 
in the discharge from the nose and ear 
in scarlet fever and measles, in the spu- 
tum, or spit, from the lungs in pneu- 
monia and tuberculosis, in the discharge 
from the bowels in typhoid fever. The 
" virus " or poison at the same time 
causes the fever and the loss of strength 
that mark the disease. The " dis- 
charges," mentioned above, carry the 
poison, which lodges in clothing, bed- 
ding, books, furniture, and wall-paper; 
and in this manner new surroundings 
and different individuals become in- 
fected, only to repeat the process and 
spread infection. In this way diseases 
become " epidemic." 

Again, the discharges may be com- 
municated through a common water 
supply or by means of a careless sewer 
system. Epidemics of typhoid fever 
arise thus. Insects and vermin also 
serve as carriers of infection. The 
germs of malaria are carried by the 

80 



FOR THE DOCTOR 

mosquito; those of relapsing fever, by 
the bedbug; fleas are responsible for 
carrying contagion, and the common 
house-fly is the worst mischief-maker. 

All infectious diseases have a " pe- 
riod of incubation." By this we mean 
the time that elapses between the ex- 
posure of the human body to the mi- 
crobe or germ and the first appearance 
of the symptoms of the disease, the 
symptoms being the result of the rapid 
multiplication of the microbes. A Ger- 
man investigator found that one and 
a half million diphtheria microbes, in- 
troduced into the blood of the body, be- 
came in six hours sixty millions, in nine 
hours five hundred millions, and in 
twenty-four hours eleven hundred 
millions. 

The " period of incubation " varies 
for different infectious diseases, and, 
because " new cases " are apt to arise 
at any time during this interval, a " pe- 
riod of quarantine " is essential for the 

6 81 



WHEN TO SEND 

protection of others against disease. 
By this we mean the length of time dur- 
ing which well people, exposed to any 
infection, must be isolated lest they 
carry the living germ to other 
individuals. 

For convenience we give the period 
of incubation and period of quaran- 
tine in the form of a " table," with 
acknowledgments to " Personal Hy- 
giene " (Walter L. Pyle), and " Dis- 
eases of Infancy and Childhood " (L. 
Emmett Holt) : 

Disease. Period op Period of 

Incubation. Quarantine. 

Small-pox 8 to 14 days 14 to 21 days 

Chicken-pox 4 to 14 days 14 to 21 days 

Measles.. 10 to 16 days 10 to 21 days 

German measles 5 to 21 days 14 to 21 days 

Scarlet fever 2 to 7 days 14 to 21 days 

Diphtheria 3 to 5 days 14 days 

Mumps 10 to 15 days 14 to 21 days 

Whooping-cough 7 to 14 days 14 days 

Pneumonia 1 to 3 days 1 to 7 days 

It ought to be unnecessary, even in 
such a book as this, to counsel that 
every instance of these acute eruptive 

82 



FOR THE DOCTOR 

diseases must have the doctor's imme- 
diate attention. Nevertheless such 
counsel is needed, for it is common cus- 
tom to avoid sending for the doctor if 
a child is thought to have a " light case 
of measles." This is not wise, or safe, 
because of certain serious after-effects 
that may follow measles, chief among 
them being tuberculosis. 

How Recognize Measles? 

We have previously described the 
warning symptoms of measles (which 
see), that appear three or four days 
before any eruption or " rash " is ex- 
pected. When this does appear, at the 
beginning of the fourth day, it comes 
in small dark-red points resembling 
flea-bites, behind the ears, on the fore- 
head, the face, the neck, the chest, and 
the back. Three days later, by the time 
the rash is found upon legs and arms, 
it has begun to fade from the face. 

In the majority of instances the 

83 



WHEN TO SEND 

" rash " is the signal for the doctor's 
first visit. This is a mistake, because 
measles is most contagious during its 
first three or four days, when the 
" cold," or catarrh of nose, eyes, and 
ears, is at its height. Should there be 
a delay in calling the doctor, make the 
child comfortable in bed in a room at a 
temperature of 68° to 70° Fahrenheit, 
well ventilated with pure air, and with 
very little light if the eyes are sensitive 
to light. Avoid bed-covering that is 
too heavy. Give the child a light diet 
of milk, or of food prepared with milk, 
or of gruels. For the fever and thirst 
give abundance of pure water to drink, 
or lemonade or orange- juice not too 
sweet, and regulate the bowels daily. 
Other directions than these must be by 
the advice of the doctor. 

German Measles. 

During an epidemic of " true " 
measles it is a common occurrence for 

84 



FOR THE DOCTOR 

a child, who has gone to bed apparently 
well, to awake in the morning profusely 
covered with pale-red spots, paler than 
those of measles and slightly darker 
than scarlet fever. Sometimes the 
spots will have " run together " into 
good-sized blotches upon the face. 
These spots, when separate, feel like 
shot under the skin. This is "Ger- 
man " measles. 

The child is usually never very sick 
with such an attack. In fact the symp- 
toms are so slight that a careful mother 
need not send for the doctor if she is 
sure that it is German measles and not 
a mild scarlatina — that being the only 
dangerous question. An almost cer- 
tain feature to help her in her decision 
will be the existence of the swollen, 
painful " kernels," or glands back of 
the neck, behind the ear. These are not 
enlarged or tender in scarlet fever. 

The disease is contagious and must 
exclude the child from school for about 

85 



WHEN TO SEND 

three weeks. He must be kept within 
doors, in a well-aired room of even 
temperature. The bowels must be 
regulated, and the food must be light, 
no meat or pastry given for three or 
four days. If the rash has disappeared 
and the glands become small or pain- 
less at the end of the first week, the 
child may be allowed to go down-stairs 
and resume his usual play. After three 
weeks he may be sent again to school. 

Scarlet Fever. 

Of these eruptive fevers scarlatina is 
the most dangerous, and fortunately 
the easiest to distinguish. The mildest 
" case " of scarlet fever must have the 
doctor's attention from the first, even 
though it is difficult to believe that such 
a statement is needed here. The writer 
has personal memories of a teacher in 
one of the public schools of new York 
City who contracted scarlet fever, prov- 
ing almost fatal to her, from two small 

86 



FOR THE DOCTOR 

Italian sisters. They spent their time 
out of school hours in flower making, 
and, because quarantine might cut the 
family income considerably, their at- 
tack of scarlet fever was not only not 
reported to the doctor, but they were 
sent to school throughout the disease. 
As it was a mild case, it w r as undiscov- 
ered until scaling or " desquamation " 
of the skin occurred. They were at 
once excluded from further school at- 
tendance, although this was too late to 
prevent the spread of infection. 

We are familiar by this time with the 
introductory or premonitory signs of 
scarlet fever (which see), — Le., a fever 
so high that the skin is burning to the 
touch, an intense sore throat, with vom- 
iting and convulsions. The sudden 
vomiting and the throat condition must 
be the signals calling in the doctor, even 
though there may be no sign of rash. 
This appears within twelve to thirty- 
- six hours after the child is stricken, and 

87 



WHEN TO SEND 

is found first upon the neck and chest. 
It appears to be made up of very small 
bright-red " points," that disappear if 
pressure is made upon them. In mild 
attacks no rash appears on the face. As 
it covers the body, the parts that are 
covered most thickly are the groin and 
armpits and the buttocks. 

A distinguishing feature of scarlet 
fever is the so-called " strawberry 
tongue." The little elevations or points 
seen always on the healthy tongue be- 
come swollen and extremely red ; at the 
same time there exists a thick white 
" fur " or coating; the red points show- 
ing through this give the appearance, 
and therefore the name, of " straw- 
berry tongue." 

Many rashes resemble that of scar- 
latina, among them nettle-rash and the 
drug eruptions already described; but 
in none of these is there found the ab- 
rupt onset, nor the peculiar condition 
of scaling that always terminates the 

88 



FOR THE DOCTOR 

disease. It is during this stage of peel- 
ing that scarlatina is most actively 
contagious. 

Scarlet fever is dreaded as much for 
its after-effects as for any of its acute 
symptoms. These are infections of the 
ears, of the joints, and acute inflamma- 
tion of the kidneys. The resulting ear 
trouble is so serious that one eminent 
medical authority has collected statis- 
tics of over five thousand deaf-mutes, 
of whom nearly six hundred owed their 
condition to scarlet fever. Another au- 
thority has found that from 6 to 10 per 
cent, of the children attacked with scar- 
latina developed an acute Bright's dis- 
ease that was not readily curable. 

Chicken=pox. 

Chicken-pox is also one of the milder 
eruptive fevers of childhood. Here, as 
in German measles, it is apt to take a 
household by surprise with its sudden 
coming. The child may be a little 

89 



WHEN TO SEND 

drowsy and may have an apparently 
fresh cold for a day or two. Upon 
waking in the morning he will show, 
over the face, through the hair, and 
scattered irregularly over the body, 
small rose-colored pimples. In four 
hours' time the pimples look like small 
blisters filled with clear fluid. By this 
time, if the mother hears that an epi- 
demic of chicken-pox is " skirting " the 
neighborhood here and there, she will 
realize the nature of the eruption. By 
the third day the " clear fluid " will ap- 
pear milky, and a few hours later the 
pimples become covered with a yellow 
crust or " scab." Five days later most 
of these crusts or scabs disappear, some- 
times leaving only faint scars in their 
wake. 

Chicken-pox, though by no means se- 
rious, ranks next to measles in the ease 
with which it is " carried " or communi- 
cated. For this reason a child suffer- 
ing from it must be kept out of school 

90 



FOR THE DOCTOR 

from two to three weeks after all the 
crusts have disappeared. 

If the mother is careful, she need not 
send for the doctor. The child must 
be kept in bed for three or four days, 
and in the room for a week. Orange- 
juice or not too sweet lemonade, if 
there be a little feverish thirst, may be 
given, avoiding meat, fats, and pastry. 

Chicken-pox and German measles 
are the two diseases to which most chil- 
dren do not object. Lasting as they 
do for but a few days, the child is not 
sick enough to need disagreeable medi- 
cation, but just enough to need a little 
special care and " coddling," with a tiny 
vacation from school. 

Mumps. 

Mumps is a disease not in such es- 
teem among children as the two diseases 
previously described, because of the ac- 
tual pain that accompanies it, 

There are in all individuals two 

91 



WHEN TO SEND 

glands rather larger than those de- 
scribed usually as kernels, one on either 
side of the neck, in front of and below 
the ear. They are the parotid glands. 
They are subject during the later years 
of childhood and youth to infection. 
This is called parotitis — in ordinary 
language, mumps. 

For a few days before they become 
infected and inflamed, the child will say 
complainingly many times a day, " I 
feel so sick." He may be slightly 
feverish and inclined to vomit ; if, after 
an attack of vomiting, eating is at- 
tempted, he will complain of " shoot- 
ing " pain below the lobe of one ear. 
It is the pain which first calls attention 
to a deep-seated swelling of the gland 
just described. The swelling may be 
slight, or it may be so great as to extend 
to the face and neck, causing the head 
to be held stiffly or to be drawn toward 
the affected side. When very large, it 

92 




Mumps. 



FOR THE DOCTOR 

gives a " foolish " expression to the 
face, making any one but the patient 
inclined to smile. He, however, is far 
from smiling, for the pain may be so 
great that he will be unable to chew or 
swallow. 

Both sides of the face are attacked, 
as a rule, though there is usually an in- 
termission of from three to seven days 
between the development on the two 
sides. 

" Mumps " is a contagious disease, 
and a child must therefore be kept out 
of school until he is entirely well. In 
ordinary attacks the doctor need not 
be sent for if the mother will keep the 
child in bed for a day or two, and 
within the house until all swelling has 
disappeared. The bowels must be kept 
open and liquid food only given, — milk, 
beaten eggs, and broths, for instance. 

In boys and girls who are develop- 
ing — i.e. j from the ages of 13 to 16 — 



WHEN TO SEND 

an attack of mumps may be more trou- 
blesome, in boys the infection going 
from the parotid glands to the testicles ; 
in girls, from the glands to the breasts 
or the ovaries. Should this occur, it 
may mean a real illness of a fortnight's 
duration, and it must in such cases have 
the doctor's careful attention. 

An after-effect very different from 
the above may at times develop, — i.e., 
deafness. An English physician has 
tabulated at least forty instances in 
which mumps resulted in permanent 
deafness, due to the travelling of the 
infection to the auditory nerve (the 
special nerve of the ear), which is 
found so near the parotid gland. The 
writer has seen at least one such result 
in which an attractive fifteen-year-old 
girl had become a total deaf-mute. 



94 



FOR THE DOCTOR 

CHAPTER X 

CONTAGIOUS DISEASES OF THE EYE 

Other Infections and Epidemics. 

Other epidemics than those of the 
eruptive febrile diseases and other 
avenues of infection spread trouble 
among children. Among these, certain 
affections of the eyes are highly con- 
tagious and call for scrupulous care. 

Epidemic Pink=eye. 

Epidemic pink-eye may spread 
through the class-room like wildfire in 
the spring and fall of the year. It is 
attended with swollen or reddened lids, 
a pinkish-red eyeball, and considerable 
discharge that flows over the cheeks in 
tears. During the day the child will 
complain that the light hurts the eyes. 
At night the discharge will " glue " the 

95 



WHEN TO SEND 

corners of the eyelids firmly together, 
and it may take half an hour of " coax- 
ing " and cleaning in the morning to 
persuade the eye to open for the day. 

Mode of Infection. 

The infection is spread by the use of 
the common wash-basin, the public 
towel, and the travelling handkerchief 
that may do more than their proper 
share of duty. 

All children affected with pink-eye 
must be excluded from school, and must 
not be allowed to return until the doc- 
tor or the school nurse is willing to give 
a " clean bill of health." To stop the 
spread of infection, the individual 
wash-cloth, handkerchief, and towel 
must be insisted upon, at home as well 
as at school. 

Gonorrhoeal Conjunctivitis or Ophthalmia. 

There is an infection of the eye, not 
uncommon in new-born babies, that is 



FOR THE DOCTOR 

highly contagious and attended with 
great danger. It shows itself within 
three days after birth, in much-swollen 
ej^elids and profuse yellow " matter " 
or discharge from the eyes. 

At the moment of its discovery the 
doctor must be notified ; everything that 
comes in contact with the baby's eyes 
must be disinfected, — the nurse's hands, 
the mother's hands, the doctor's hands. 
All cloths and cotton lint used for 
cleaning must be burned without delay. 
Should the condition be neglected, 
blindness may occur. Before the in- 
fectious nature of this inflammation of 
the eye was discovered, the resulting 
blindness was so common that thirty 
out of every hundred blind adults 
traced their blindness to this cause at 
birth. 

Occasionally, because of vice and low 
living in crowded tenement districts, 
the eyes of older children become in- 
fected in a similar manner. Should this 

7 97 



WHEN TO SEND 

happen, such children must be ex- 
cluded from school and be " followed 
up " for rigorous treatment, either by 
the family physician, a dispensary doc- 
tor, or the school nurse. 

Trachoma. 

Among the children of very recently 
arrived immigrants trachoma is found. 
This is highly contagious, and, if not 
treated medically, will result in blind- 
ness. Eyes infected with this treach- 
erous disease discharge thick yellow 
" pus " or matter. In addition, there 
will be found, in the little folds of the 
lids, row upon row of gray-white 
grains, like sago in appearance, or, ac- 
cording to another authority, frog- 
spawn. As the lids heal, these rows 
contract into deep scars along the lids, 
sometimes narrowing the latter into 
mere narrow ugly slits, through which 



FOR THE DOCTOR 

the eyes seem to peer, giving an almost 
sly or sinister expression, 

A child afflicted with trachoma must 
be kept out of school until all suspicion 
of discharge is removed. So contagious 
is trachoma that the United States 
Government is giving aid in stamping 
out this evil by isolating all immigrants 
suffering therefrom in the Government 
Hospital on Ellis Island in New York 
Harbor. 



99 



PART II 

SIMPLE AND SERIOUS NERVE DISORDERS 



CHAPTER XI 

NERVOUS DISEASES 

Nervous Diseases of Children. 

What are the signs of nervous dis- 
eases among children? Are they read- 
ily detected? Are they serious in them- 
selves? Do they point to serious con- 
ditions always? Of one thing let us 
make sure at the start. Any and all 
symptoms of nervousness must be re- 
ported at once to the doctor, because 
he is the judge of their importance. Of 
one other let us be equally careful : 
That very young children be kept quiet, 
that all excitement be avoided, that 
noisy amusements and romping at even- 
ing be absolutely prohibited. 

If a child does not sleep or rest well, 
it must be trained into habits of sleep, 
as well as trained into habits of exer- 
cise. It should be taught to expect be- 

103 



WHEN TO SEND 

ing put into crib or cradle alone, and 
then to go to sleep without coaxing or 
rocking, or walking, or, again, as once 
before prohibited, without sucking the 
rubber nipple and ring known as the 
" pacifier." There ought to be no 
nursing between eleven or twelve 
o'clock at night and four o'clock in the 
morning. After a baby is five months 
old there should be no nursing between 
ten o'clock at night and six or seven 
o'clock in the morning. 

A child's nervous system grows with 
great rapidity. It shows greater 
changes in small intervals of time than 
any other part of his body. It needs 
to do so to fit him into or to let him be- 
come a part of the new world around 
him. A new noise or sound, a new 
face, a new color, a new toy, for each 
of these he must be ready. Because of 
this the nervous system is constantly 
having to " adjust " or fit itself into the 
new impression. Hence we call it un- 

104 



FOR THE DOCTOR 

stable or unsteady. This explains why 
slight causes make great impressions 
upon a child's nervous system. For in- 
stance, a mild attack of indigestion may 
excite a severe convulsion, so also may 
the presence of worms in the bowel. 

A slight amount of eye-strain, or an 
adenoid of moderate size, or impacted 
teeth — any of these may be the cause 
of a troublesome attack of St. Vitus's 
dance. Let us understand, therefore, 
that " nervousness " does not always 
arise from deep-rooted or hopeless dis- 
ease of the central nervous system in 
itself. 

Convulsions. 

Few illnesses of childhood alarm a 
mother more than the first attack of 
convulsions she may have to witness. 
Nevertheless, they do not always pre- 
sage alarming disease. No matter what 
their cause, if once seen, they are al- 
ways dreaded. Slight twitching of the 
muscles of the face, the eye-lids, the 

105 



WHEN TO SEND 

hands and feet may give a merciful 
warning of what is to follow. Occa- 
sionally this does not happen, and, in- 
stead, the convulsion may come upon 
a child in perfect health, like a light- 
ning bolt, with pitiful rolling of the 
eyes, hard jerking and twitching of all 
the muscles of the body; the face dis- 
torted in its expression, the saliva flow- 
ing or frothing from the mouth; the 
fists tightly closed; arms and feet are 
bent and stiff. The breathing becomes 
shallow; the lips almost blue, and the 
forehead wet with perspiration. Al- 
though these last but a few minutes 
really, the time drags for the mother, 
and she is easily wont to think the con- 
vulsions " lasted for half an hour," as 
she tells the doctor. As the attack sub- 
sides, the child probably falls into a 
stupor that may pass into sound and 
comfortable sleep, from which he may 
awake as though nothing unusual had 
happened. On the other hand, a first 

106 



FOR THE DOCTOR 

attack may be followed by others, and, 
no matter how trivial the cause is found 
to be, the fact remains that the ner- 
vous system once upset by so slight a 
thing is in itself unsteady. How 
may we determine the cause of the 
convulsion? 

Indigestion. 

If, in infancy, it arises from indiges- 
tion, there will be a history of improper 
feeding; obstinate constipation may 
have preceded the attack; an outburst 
of temper and wrath from mother or 
wet-nurse prior to nursing may be the 
cause. 

Scarlet Fever and Pneumonia. 

We have spoken before of the con- 
vulsions that usher in scarlet fever and 
pneumonia. In the former, intensely 
sore throat and vomiting, in addition 
to the convulsion, will be the danger 
signals. If a severe chill that shakes 

107 



WHEN TO SEND 

the body from head to foot precedes or 
follows the convulsion, pneumonia is 
doubtless threatened. 

Acute Meningitis and Cerebrospinal Men* 
ingitis. 

The convulsions that introduce acute 
meningitis are attended by high fever 
and the " projectile " vomiting already 
described (which see). Moreover, the 
convulsion is apt to be limited to one 
side of the body, a fact to be always re- 
membered. These are the convulsions 
that are so frequently followed by sud- 
den paralysis of different parts of the 
body, — of one arm, or of one leg or 
foot. 

What to do for Relief of Convulsions. 

In older children convulsions may be 
epileptic in nature. If this is true, they 
are preceded by a peculiar moaning cry, 
by a fall, or by a ringing in the ears. 
During the convulsion the tongue will 

108 



FOR THE DOCTOR 

be bitten, and the ordinary froth at the 
mouth will be streaked slightly with 
blood. Rickety children are apt to 
have convulsions. 

Whatever the cause for the convul- 
sions, the treatment must be prompt. 
Let the child be stripped and laid upon 
a blanket, at the same time covering 
the entire trunk with a large towel or 
small sheet dipped in mustard water 
prepared by mixing one tablespoonful 
of ground mustard with one quart of 
tepid water. After wrapping the 
towel or sheet around the body, wrap 
the child in the blanket upon which it 
has been lying and let it be undisturbed 
for fifteen minutes. All treatment 
must be directed by the physician, who 
must remain until the convulsion has 
entirely ceased, 

" Fits " or Epilepsy. 

Convulsions of infancy sometimes 
become the more chronic epileptic at- 

109 



WHEN TO SEND 

tacks or " fits " of later childhood, es- 
pecially if there be a trace of nervous 
inheritance from any member of the 
child's family. One authority tells us 
that in one-third of the children who are 
" subject to fits " there is a family his- 
tory of epilepsy or insanity. Although 
this is true, some fresh cause is found 
in almost every instance, as fright or 
great excitement, a blow or a fall on 
the head. 

The " fit " consists of hard convul- 
sions lasting sometimes fifteen minutes, 
during which time the child grows un- 
conscious. There is apt to be a warn- 
ing of the fit. It may be a chill all over 
the body or a feeling of f aintness, some- 
times a ringing in the ears, or flashes 
of light before the eyes. During the 
fit the face grows pale, eyes staring 
with wide-open pupils, and, as the con- 
vulsion reaches its worst, the child falls 
to the floor, or to the ground, with a 
little hoarse cry. 

no 



FOR THE DOCTOR 

There is frothing at the mouth which 
is streaked with blood, caused by the 
biting of the tongue, as the teeth are 
working and clenched. After the con- 
vulsion is over, the child is apt to drop 
into a sound sleep lasting for an hour 
or more. On awakening he will com- 
plain of a headache. 

When fits occur during the night, if 
the child sleeps alone or in a separate 
room, he may have several attacks 
without the knowledge of the mother 
or nurse. In this case, if she finds 
blood upon the pillows (from the bit- 
ten tongue) and the child complains of 
severe headache in the morning, she 
must be on her guard for the true na- 
ture of these nightly attacks. 

" Spells." 

At times a child may have " spells," 

or attacks in which he will tell you that 

for a few minutes he has been very 

" dizzy," or that he felt very " weak " 

111 



WHEN TO SEND 

(this in reality amounting to a mo- 
mentary fainting). If he is watched 
at any time through such a " spell," he 
is found to be unconscious. This, 
taken with the fact that such attacks 
recur at seemingly regular times, will 
stamp them as mild epileptic seizures. 
Despite this, they indicate a condition 
of the child's nervous system serious 
enough to be brought at once to the 
doctor's attention. 

For the more severe form of the 
seizures nothing can be done to " cut 
short " an attack. Simply make the 
child comfortable by loosening the 
clothing about the neck, waist, and 
wrists, and place him upon his back 
with his head slightly raised on a soft 
pillow. In addition, take the precau- 
tion of putting a spool or cork, or 
clothes-pin, between the teeth, to pre- 
vent, as far as possible, the biting of 
the tongue. Doctor Emmett Holt de- 
ns 



FOR THE DOCTOR 

clares that " an epileptic child should 
never be without an attendant or 
companion." 

The doctor's work in epilepsy is to 
discover and remove, if possible, the 
cause of the disease. Unless this is 
done, there is no " magic cure " for the 
condition. 

Night Terrors. 

A child that has gone quietly to 
sleep, apparently well, may, after an 
hour or two, suddenly awake with a 
scream that frightens the entire house- 
hold. His fright may be so great that 
he will recognize neither mother nor 
nurse. If asked to tell of the thing 
that has made him afraid, he may point 
to a (supposed) object under the bed, 
or in a corner of the room. After a 
little comforting, the child may sob 
himself to sleep in his mother's arms, 
and the remainder of the night may 

' 8 113 



WHEN TO SEND 

be undisturbed. Sometimes such a 
condition will recur nightly and at the 
same hour for two weeks at a time; or 
months may pass without a similar 
occurrence. 

Such a child and such attacks must 
be treated with gentleness and for- 
bearance. He must not be made to 
sleep alone, but be allowed to have his 
crib beside the bed of the nurse or 
mother. 

Should attacks be frequent, the doc- 
tor's attention must be called thereto, — 
for there may be a hidden cause re- 
sponsible for them, which only he can 
discover. More than one medical au- 
thority declares that, as the child with 
night terrors grows older, they are re- 
placed by attacks of epilepsy. 

St. Vitus's Dance (Chorea). 

A child who is considered merely 
" nervous," or irritable, may develop 

114 



FOR THE DOCTOR 

what appears to be a " habit " of drop- 
ping things, — his books, pencils, or, at 
table, his knife or fork, or glass of milk. 
He may fumble badly at buttoning his 
clothes or lacing his shoes, for all of 
which he is most apt to be scolded. 

This is a mistake, for a child show- 
ing these signs is probably developing 
an attack of St. Vitus's dance, a trou- 
blesome nervous disease of childhood. 
If he is not taken to the doctor as these 
symptoms show themselves, he becomes 
gradually worse. 

By degrees all the muscles of the 
body become affected: those of the 
face — when he may be chided for 
" making faces," those of the hands, 
arms, legs and feet; when the disease 
is at its height, these are in almost con- 
stant motion, jerking and twitching ir- 
regularly, and are made worse by any 
attempt to stop them. 

A child showing the slightest ten- 

115 



WHEN TO SEND 

dency to St. Vitus's dance must be 
taken out of school at once, and put 
under careful medical supervision. He 
must not be scolded or ridiculed because 
of the uncontrollable movements; and, 
though one attack may be cured with 
comparative ease, the mother must be 
on her guard for the repetition of the 
trouble at any time that overstrung 
nerves or childish over-anxiety may get 
" the upper hand." 

Hysteria. 

An outbreak of hysteria in a child 
may resemble St. Vitus's dance. Hys- 
teria may mimic any really serious dis- 
order. How then is a mother to know 
the difference between an hysterical 
outbreak and the real St. Vitus's dance? 
The twitching or tremors of hysteria 
are more regular; they do not last for 
any great length of time, as in 
" chorea "; they end abruptly; at times 

116 



FOR THE DOCTOR 

they show a remarkable tendency to 
improvement or even actual disappear- 
ance if but little attention or sympathy 
is given to them. 

Habit Spasms. 

Some nervous children have a ten- 
dency to the development of certain 
" habit " spasms, and these may resem- 
ble at times the beginning of St. Vitus's 
dance. Let us remember this differ- 
ence, however, — that a habit spasm af- 
fects only one set or group of muscles, 
as in the blinking of the eye, frowning 
of the forehead, nodding of the head, 
or shrugging of the shoulders, while in 
chorea different muscles of the body 
are jerking in irregular motions at one 
and the same time. 

Annoying as these habits are, pun- 
ishment does not correct them. A child 
so affected must have the doctor's ad- 
vice and careful patient attention. 

117 



PART III 

SOME HABITS OF CHILDHOOD 



CHAPTER XII 

CERTAIN NERVOUS HABITS 

Enuresis (Incontinence or Bed=wetting). 

We may include this condition 
rightfully among the " nervous disor- 
ders " of childhood, for such it is, at 
least occasionally. At other times it 
goes in company with the nervous con- 
ditions we have described above. 

Sometimes an irritated condition of 
other near-by organs may cause bed- 
wetting, as pinworms in the lower 
bowel, or a long or exceptionally tight 
foreskin. Sometimes actual disease of 
the bladder itself may be the existing 
reason, as a small " stone " in the blad- 
der or very highly-acid urine. 

The bed may be wet by night and the 
child's clothing by day. 

The chief reasons for mentioning at 
121 



WHEN TO SEND 

length the cause is to impress upon the 
child's care-taker that nothing but 
medical advice is to be thought of, if 
the child should be troubled with this 
condition. Punishment of any kind is 
useless. Even though, after the dis- 
covery and removal of any of the causes 
above enumerated, the disorder seems 
to have grown into a " habit," scolding 
will be ill-advised. Patience on the 
part of the mother or nurse and pride 
and cleanliness on the part of the child 
will, in connection with the doctor's 
management, secure better results than 
all whippings can accomplish. 

Certain Habits of Infancy and Childhood. 

It may not be amiss in this connec- 
tion to speak a word of warning against 
particular habits that are encountered 
in infancy and childhood. As, for ex- 
ample, " sucking," — i.e., sucking of the 
thumb or finger, or of a rubber nipple. 
122 



FOR THE DOCTOR 

Such habits are sometimes regarded as 
harmless, but the truth is they leave 
disastrous effects if not broken early. 
Deformity of the thumb or finger or of 
the lips and jaws is the result. The 
formation and growth of adenoids are 
encouraged. One authority (Emmett 
Holt) states that habitual sucking of 
one finger or hand may lead to spinal 
curvature. Worst of all, the habit of 
masturbation may be fostered by per- 
sistent sucking. 

Masturbation or SeIf=Abuse. 

The foundations for this habit are 
often laid in infancy or early childhood. 
On account of the seriousness of the 
practice if not discovered, it should be 
" nipped in the bud " if possible. Other- 
wise it may lead to a complication of 
physical and moral diseases. 

We have known children of ten years 
of age who have been like " centres of 

123 



WHEN TO SEND 

moral infection," because of teaching it 
to others and so spreading the habit 
through schools, public or private, 
through " reformatories," and asylums. 

How shall a mother detect the first 
sign of the habit? In very young 
babies it is discovered in a frequent rub- 
bing together of the thighs, sometimes 
by rubbing the body against a soft 
warm pillow. 

Sometimes the child will simply lie 
upon the floor with the thighs crossed 
and rigidly held, and only a backward 
and forward motion of the body is 
made. This lasts for a few moments, 
and is accompanied with flushing of the 
face and a little excitement, followed 
finally by a " letting go," and afterward 
by perspiration. 

If the child is in care of a nurse, her 
first suspicion of such a condition must 
be reported to the mother, who must 
herself make the doctor her first con- 

124 



FOR THE DOCTOR 

fidant. It may be possible that some ir- 
ritation is being produced by thread- 
worms; or, in girl babies, a slight dis- 
charge from the tiny vagina, or middle 
passage; in boy babies, an over-tight 
foreskin. Should the doctor find any 
of these existing, it will be compara- 
tively easy to break the evil habit. If 
none of these exist, the problem is more 
serious, and, in addition to the doctor's 
resources, calls for all the tact and pa- 
tience and loving wisdom that the 
mother possesses. 

Fatigue. 

It has come to be a matter of com- 
mon understanding that when we speak 
of being fatigued, or tired, we give per- 
haps our first attention to our muscles. 
Thus, finding we cannot walk a mile, 
or a block further, we at once say we 
are " tired," or, discovering that we can- 
not finish this or that task of the hands, 

125 



WHEN TO SEND 

we call ourselves " too tired." As a 
matter of fact, however, the " nerve- 
centres " of the body are the first to 
know the effects of fatigue or weari- 
ness. Because they are tired first, they 
cannot whip up or spur up the muscles 
to brisker action. All this is seen 
vividly in the fatigue of exhaustion so 
prone to come upon the school-child of 
to-day. Shall we try to draw a pic- 
ture of such? If we draw truthfully, 
we will find a head no longer erect on 
the shoulders, but drooping; we will see 
drooping eyelids, a face unsmiling, with 
perhaps open mouth; the face and lips 
are puffy and pale. The hands have 
lost color and grip, perhaps the fingers 
are twitching. So much for the bodily 
picture. What is the child's condition 
of mind? Restless, inattentive, and 
" fidgety," — answering slowly if asked 
a question, moving slowly if ordered to 
do a thing, with a puzzling, sudden loss 

126 



FOR THE DOCTOR 

of memory, a monotonous " tired " 
voice, finally a decided mental irritabil- 
ity, which " will be shown by saying or 
doing the wrong thing under the cir- 
cumstances." Such a child will sleep 
poorly, perhaps talking, or even, at 
times, walking in his sleep. 

What shall be done with this child? 
Shall he be punished because he does 
not " pay attention " in school, or be- 
cause he is dropping behind his class, 
or because he cannot study at home, or 
because he takes no interest in things 
generally? No, the child needs first to 
be " rested," to be taken out of school, 
to be kept in the sun and the best air, 
and to be given the doctor's careful at- 
tention as to food, sleep, and exercise. 

Should any or all of these measures 
be neglected, such a child may develop 
the hysteria of which we have already 
spoken, or an attack of St. Vitus's 
dance. Even a permanent break-down 
is a possible result of neglected fatigue. 

127 



PAUT IV 



PHYSICAL AND MENTAL CAUSES OF 
RETARDATION 



CHAPTER XIII 

COMMON PHYSICAL DEFECTS 

There is a realm in which the ques- 
tion, " When to send for the doctor? " 
is becoming increasingly important. It 
is a comparatively new field of medical 
and psychological investigation. It has 
been brought to notice recently by the 
studies of backward children in the pub- 
lic schools. Investigations made in 
thirty-one large cities in the United 
States show that about 33 per cent, of 
the 20,000,000 school-children are behind 
the grades they should be in for their age. 

The causes for this condition are 
manifold and various. What all of 
them are no one knows. In general, 
however, we can say that the majority 
of causes are either physical or mental. 
When, therefore, a child does not make 
good progress in school, it is considered 

131 



WHEN TO SEND 

a case for medical or psychological 
advice. 

Nearly all the purely physical causes 
of backwardness are removable. An 
early and careful medical diagnosis 
will, therefore, save the child from much 
lagging in his school- work and the par- 
ents from useless worry. Such defects 
as adenoids, enlarged tonsils, poor eye- 
sight, ear-ache and poor hearing, de- 
cayed and aching teeth, malnutrition, 
and many other physical conditions, 
formerly hardly noticed, will not only 
affect the learning ability of the child, 
but will also ofttimes make him a bad 
boy. A cross, peevish, irritable, stub- 
born child, who may steal, lie, and play 
truant, can often be changed into a 
model of good conduct by proper medi- 
cal attention. These facts of modern- 
day science make it extremely impor- 
tant for both parents and teachers to 
know when to send for the doctor. 

132 



FOR THE DOCTOR 

The children who cannot get along 
in school because of physical defects 
can usually be recovered from their 
backwardness by removing the defects. 
Unfortunately, there is another larger 
and increasing class of retarded chil- 
dren who can never be cured com- 
pletely. They are suffering from some 
mental defect that show T s itself not only 
in school but also in an inability to per- 
form many simple acts of every-day 
life such as normal children do. In the 
United States to-day there are from 
150,000 to 300,000 such children. If 
the parents could only understand early 
enough that something seriously was 
wrong with children of this type and 
would take them for an early examina- 
tion by a specialist, many of them could 
be educated from a state of helpless- 
ness to a state of self-support. 

For such a result the child should be 
examined in infancy. This should be 

133 



WHEN TO SEND 

done by a specialist. For the treatment 
should begin early and should be car- 
ried out in the proper way. Neglect 
will injure such a child. Bad training 
will injure such a child. Many a piti- 
ful case comes to the attention of the 
specialist where the best-intentioned ef- 
forts of the parents have caused only 
injury to their poor child. How infi- 
nitely better it would have been for all 
concerned if the parents had known 
" when to send for the psychologist!" 
What is true for the parents is 
equally true for the teacher. It is es- 
timated that one-half of one per cent, 
of the total number of public-school 
children is mentally defective. Whether 
these data are precise or not, it still re- 
mains true that the public-school 
teacher, both in regular and special 
classes, meets frequently children who 
are retarded, and she must decide 
whether they are retarded from physi- 
cal defects or from mental defects. In 

134 



FOR THE DOCTOR 

other words, she must know enough at 
least about the condition of things to 
determine whether the child should be 
sent to a medical specialist or to a psy- 
chologist; and if it is not possible to 
send the child to a specialist, she pre- 
eminently must know enough of this 
class to decide on the pedagogical indi- 
vidual needs of the case. Otherwise 
she may by mistaken training inflict in- 
jury on the weakened intellect instead 
of improving it. 

In the following pages we will give 
in the simplest way possible the signs 
of, first, those physical defects which 
should be called to the attention of a 
medical specialist; and, second, those 
which should lead the parent or teacher 
immediately to take the child to a men- 
tal specialist for a full examination. 

Note. — For a complete discussion of this subject the 
reader is referred to The Conservation of the Child, by 
Arthur Holmes, 1912, J. B. Lippincott Co., Philadelphia; 
, price, $1.25. 

135 



WHEN TO SEND 

Of these purely physical defects we 
find defective hearing, defective vision* 
defective breathing, defective speech, 
defective teeth, defective posture, most 
often. 

We are paying more attention to the 
conditions to-day because we are 
obliged to do so. Health in these days 
is regarded as a " civic obligation," or, 
in other words, a public duty; as much 
so as the cleanliness of a city's streets 
and the disposal of its garbage. 

Value of Present=day Physical Examination* 

Our school-children are expected to 
undergo quite as careful and frequent 
physical examinations and re-examina- 
tions as they were made formerly to 
pass in arithmetic and geography. 
Therefore it behooves us to have an in- 
telligent idea of these common physical 
defects and to be able to recognize the 
first danger signals they throw out. 

136 



FOR THE DOCTOR 

Within the last five years Dr. Leon- 
ard Ayres made an examination of 
3300 school-children in New York 
City, from ten to fourteen years of age. 
Among them more than four hundred 
were found " dull," or retarded and 
backward in their grades. Three- 
fourths of the number were shown to 
possess poor vision, poor hearing, poor 
breathing, and poor teeth, and it was 
proved clearly that these very defects 
were largely the cause of their poor 
progress in school. 

Defective Vision, 

What are the signs of defective 
vision? They are numerous; among 
them being frequently occurring head- 
aches, especially those accompanied 
with sick stomach and vomiting; also 
frequent styes; blurred vision; habits 
of winking and squinting; curious 
habits of holding a book when reading, 

137 



WHEN TO SEND 

either more or less than nine inches 
from the eyes; a strained or worried 
expression when reading; stooped 
shoulders, with twisted head and neck; 
all arising from the effort to adjust or 
fit the eyes for the distance or object 
it tries to see. Even pronounced spinal 
curvature, with obstinate backache and 
neuralgia, may follow these tricks of 
adjusting if the cause be not discov- 
ered. 

If the mother has not discovered that 
her child has poor vision before he goes 
to school, the teacher or school nurse 
will doubtless detect it and ask at once 
for an oculist's examination. 

In some cities and states not yet em- 
ploying a school oculist or a school 
nurse, the teacher is expected to test 
and record the acuteness of vision of 
her pupils by means of the " Snellen 
Test Card." 

This consists of a pasteboard card 

138 




fat h 

o a *x 





H t 



x t ifl « e 

t • ^ o * M 



w x * O t * 

X t M ffi «»f * O 

•r D u r - Reber ' s "Kindergarten Test" card, to be used in place of "Snellen Card," 
oblS^ch^iu^ aCtUa ' Card measures 22 * » inches - and the «p line 



FOR THE DOCTOR 

with nine rows of letters, each row of 
different sized type and intended to be 
read at varying distances, the largest 
type at 200 feet, the smallest at ten. 
The card must be hung in a good, clear, 
side light, on a level with the child's 
head. The child may be placed at ten 
feet distant from this, and, covering 
one eye (not pressing upon it) with a 
card held against nose and forehead, 
he is asked to read, with the other eye, 
the different types. If, at the actual 
distance of but ten feet, he can read 
the letters that should be read at a dis- 
tance of twenty feet, he is recorded 
as being near-sighted " with 10/20 
vision "; if, at ten feet, the letters that 
should be read at thirty or forty feet, 
he is recorded as having " 10/30 or 
10/40 vision." Each eye must be tested 
separately. 

A " far-sighted " child will need to 
be tested with lenses, and this, of course, 

139 



WHEN TO SEND 

must be done by a competent oculist. 
There are other defects of vision, as 
those of astigmatism and of lack of ac- 
commodation, that must have the ocu- 
list's care. Any and all of these are 
evidenced by the signs we have already 
described. 

Causes of Poor Vision. 

What are the causes of defective 
vision so rife among our children? 
School life itself is the chief factor, since 
it means the necessity of constant 
strained attention for near view, 
whereas the child is born equipped for 
seeing things at long range. Excessive 
use of the eyes, poor light, poor type, 
poor ink, poor paper, are all causative 
of poor vision. 

School-books should be printed on 
dull-surfaced paper, rather than on the 
glazed that is so often used. That a 
letter smaller than one-ninth of an inch, 

140 



FOR THE DOCTOR 

or " long primer " type, should be for- 
bidden absolutely, is the verdict of the 
most careful authorities. 

Badly proportioned desks and seats, 
compelling the pupils to adjust the eyes 
for too close range, and defective 
lighting of the school-room are fre- 
quent, if not universal, causes of eye- 
strain. Seats should be adjustable, and 
easily so, without elaborate or " fussy " 
contrivance. 

Most recent authorities favor such 
construction as the following: " The 
edge of the desk should project slightly 
over the edge of the seat. The top of 
the desk should incline downward from 
the horizontal about ten degrees to- 
ward the student, and be low enough 
to allow the forearm to rest without 
raising the shoulder. The seat should 
be sufficiently broad to support almost 
the whole thigh and close enough to the 
floor to allow the soles of the feet to 

141 



WHEN TO SEND 

rest thereon. It should be slightly hol- 
lowed to prevent slipping, and per- 
fectly horizontal rather than inclined. 
The back should be curved forward to 
support the loins and to make it easy 
and comfortable for even weakly chil- 
dren to sit upright." 

All light should come from the left, 
or from the left and rear of the desks. 
Charts, maps, and blackboards must 
not be placed between windows, and 
the latter must be chosen with dead 
black, not glossy, surfaces. 

If the windows are spaced about six 
feet from the floor, the direct rays of 
light need not strike the teacher's eyes 
as she faces a class. There should be 
at least one square foot of window space 
to each four square feet of floor space. 

Dr. Risley, one of the best ophthal- 
mologists, gives the following as dimen- 
sions of an ideal school-room: 

142 



FOR THE DOCTOR 

Height of ceiling 15 feet 

Length of room 32 feet 

Width of room 24 feet 

Blank wall (rear of room) 4 feet 

Blank wall (front of room) 4 feet 

Space allowed for group of windows .... 24 feet 

When teachers and parents unite in 
demanding healthful conditions in 
school building, even architects will be 
persuaded to yield to public opinion, 
and the up-to-date school-house will 
serve its purpose with far greater 
efficiency. 



143 



WHEN TO SEND 



CHAPTER XIV 

DEFECTIVE HEARING 

Defects of Hearing. 

Within the last five years greater 
attention has been given to defects of 
hearing among school-children. Is it 
possible for a child to reach school age 
without being suspected of dulness of 
hearing? Yes, particularly if it be but 
slight, in which case the child, if at all 
bright, depends much on watching or 
" reading " the eyes and lips and the 
facial expression of those around him. 
On the other hand, apparently slight 
trouble with the ears is too often ne- 
glected. Repeated attacks of ear-ache 
are apt to receive scant attention until 
some discharge from the ear is seen, 
and, though this is a signal for the doc- 
tor's visit, it is usually too late to pre- 
vent disaster. 

144 



FOR THE DOCTOR 

An aching ear, instead of being 
washed with hot tea and poulticed with 
hot bread, needs the doctor always. 
Says Dr. Ernest Hoag, " The common 
habit of putting good food in bad places 
would be funny if it were not often so 
serious a matter. Sore throats are 
wrapped with bacon, sore chests cov- 
ered with stewed onions, boils are poul- 
ticed with bread and milk, and various 
other articles of food are wasted on the 
outside when they might do much 
greater good on the inside." The pro- 
miscuous dropping of oil, whether 
heated or not, or yeast, into the ear, is 
no less dangerous than any of the above. 

If a child be born deaf, it is difficult 
for any one to detect the condition for 
the first year, or year and a half, at the 
end of which time the mother listens 
expectantly for the first words that 
childish speech brings forth. If she 
listens, only to be bitterly disappointed, 
hearing nothing, alarm will send her 

10 145 



WHEN TO SEND 

to the nearest specialist. But even he, 
at this early age of the child, will find 
it extremely difficult to determine the 
extent of deafness. 

How is deafness to be suspected in 
an older child at school? By restless- 
ness or inattention in the class-room ; by 
the stupid expression of face, or by the 
dull monotonous voice; by poor spell- 
ing, and careless or imperfect speech. 
When any or all of these are present 
in a child, both teacher and parent must 
insist upon careful tests of his hear- 
ing. A child with good hearing should 
detect the ticking of a watch at a dis- 
tance of two feet, a loud whisper at 
twenty-five feet. 

A simple though crude group test 
may be carried out by placing all the 
children in the room at the limit of or- 
dinary class-room distance. Let all 
close their eyes; then order them in a 
whisper to perform an unexpected 

146 



FOR THE DOCTOR 

movement, such as the placing of the 
right forefinger on the palm of the left 
hand. Repeat with similar commands. 
Note any children who fail to respond, 
or who appear to do so in imitation of 
the others. Report such children for 
more careful and individual tests by the 
school doctor or the private specialist. 
Older children may be taken in 
groups of tens and ordered to write, on 
pads of paper, whispered numbers. 
The paper should be checked and no- 
tice taken of all who require more care- 
ful or individual tests. Like the above, 
these need to be given by the specialist 
or aurist. 

Causes of Deafness. 

One of the commonest causes of 
deafness, other than actual disease of 
the ear, is the presence of adenoids and 
enlarged tonsils. The latter are two 
glands, seen at the back of the throat, 

147 



WHEN TO SEND 

one on either side of this passage-way. 
In perfect health they are about the 
size of the thumb-nail, from an eighth 
to a quarter of an inch in thickness, and 
hang partly " free " or loose in the 
throat. They show, however, all possi- 
ble differences in size, and may be so 
large as to meet each other in the mid- 
dle of the throat, thus causing a de- 
cided obstruction. 

Adenoids are soft spongy growths 
found above the tonsils, at the upper 
part of the throat, back of the nose, 
where they cannot be seen without a 
special throat-mirror. If the child be 
a sufferer from repeated colds, these 
growths may become quite hard. 
Whether soft or hard, they, with en- 
larged tonsils, block or obstruct free 
breathing through the nose, and the de- 
formity of the flat nose and flat " dish- 
like " face is the result. In addition 
they spoil the shape or " set " of the 

148 



Fr 

droo 

post 


^^^^^ ^^^*^1 


ont view of adenoid face. Mark 
open mouth, broad-bridged nose, 
ping eyelids, and drooping 

inc. 


Wry — - S %. 

— 1 w 


Side view of adenoid case. Note the 
flat chest, drooping shoulders, curved 
back-bone, open mouth, and air of 
weakness. 


mm W^^m. H 



FOR THE DOCTOR 

jaws, crowding the teeth so badly that 
eating is interfered with. The upper 
jaw is apt to overhang the lower, the 
lower jaw is " dropped," with mouth 
habitually open, and the constant habit 
of mouth-breathing ensues. 

As if this were not enough mischief 
to make, they are sometimes largest at 
the very point in the throat which 
marks the opening of the inch-and-a- 
half-long passage or tube leading from 
the throat to the middle ear. Ninety 
times in a hundred, the pressure that 
adenoids and enlarged tonsils make 
upon this small tube produces so much 
inflammation that catarrh of the mid- 
dle ear results, ending finally in 
deafness. 

The stupid countenance resulting 
from the habitually open mouth, and 
the inevitable mouth-breathing accom- 
panying it, should be enough to put any 
mother upon her guard. The doctor's 

149 



WHEN TO SEND 

advice must be sought without further 
delay, and he will doubtless counsel, at 
once, the removal of the adenoids and 
tonsils. 

This is by no means a dangerous op- 
eration, but it needs to be done with 
great thoroughness, to produce the 
complete disappearance of all the ob- 
jectionable conditions we have de- 
scribed. 

Temporary Deafness. 

Temporary deafness may be caused 
by the long and obstinate accumulation 
of hardened wax within the ear canal. 
Such deafness is apt to occur suddenly, 
because with even the smallest possi- 
ble slit-like opening in the mass, the 
child can hear. It takes months for 
such masses to collect within the ear 
without causing damage until sudden 
moisture, or even damp weather, causes 
the wax to swell, large enough to close 

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How to look into the ear without using instruments. 



FOR THE DOCTOR 

the opening and prevent the passing 
of any waves of sound within the canal. 
If this occurs, the mother will be able 
to detect the dark reddish-brown mass 
of wax, by gently drawing the lobe of 
the child's ear upward and slightly out 
or away from the side of the head. She 
must take the child to the doctor or to 
the nearest dispensary, doing nothing 
herself to remove the mass. In the doc- 
tor's skilled hands, careful syringing 
with sterilized boiled water will remove 
the mass, although it may consume sev- 
eral minutes. Under no condition is 
the mother or child at any time to keep 
continually prodding the ear to remove 
smaller masses of wax. These roll out 
of themselves, often unnoticed ; the ten- 
dency to collect in larger masses is a 
sign that too much prodding has been 
done and that the ear has been 
irritated. 

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WHEN TO SEND 

Foreign Bodies in the Ear. 

Children sometimes, through mis- 
chief or curiosity, put shoe-buttons, 
pebbles, beads, beans, or peas into their 
ears. Usually these objects are small 
enough to come out as easily as they 
entered, if their removal is attempted 
by the skilled doctor. 

It is only when the unskilled, un- 
trained hand tries to remove the in- 
truder that injury is done. It may be 
a strong temptation for mother or nurse 
to attempt to do this, but in her desire 
let her remember the old caution, 
" Never put anything smaller than 
your elbow into the ear." 

Defects of Breathing. 

Not only is proper breathing through 
the nose obstructed by adenoids and en- 
larged tonsils, but " all the way down 
the line " mischief is done. 

Because insufficient air is admitted, 
the lungs do not receive their proper 

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FOR THE DOCTOR 

supply. When the lungs are abused 
in this fashion, the chest walls have no 
opportunity or call to action, and, in- 
stead of a well-developed, full-chested 
boy or girl, we find the chest flat and 
sunken, with great hollows under the 
ribs, and stooping shoulders. As the 
ribs fall in, the breast-bone is pushed 
forward conspicuously, and we have as 
a consequence the flat-chested, " pig- 
eon- " or " chicken-breasted " child, as 
another result of adenoids. Moreover, 
he will be pale, because he is not getting 
enough good air to keep his blood of a 
good red color. He will be stupid and 
drowsy, because not enough red blood 
is sent to his brain to keep it awake and 
at work. The flat-chested boy or girl 
is the one liable in later life to become 
the consumptive or " tubercular " child. 
It is difficult to state where the mischief 
ends that is produced by the trouble- 
some adenoids and tonsils of which one 
hears so much. 

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WHEN TO SEND 



CHAPTER XV 

DEFECTIVE TEETH 

Defective Teeth. 

Surely we all recognize poor teeth 
when we see them. Is not the thing we 
need most to recognize or realize — be- 
fore the trouble is made — what causes 
poor teeth? 

We have already made mention of 
the deformed jaw with its crowded, 
overlapping teeth, of which adenoids 
are the cause. 

Crooked teeth may result also from 
the neglect of the first set of teeth in 
childhood. If through lack of care 
these first teeth decay early, they must 
be filled, or, if too far gone, removed. If 
their roots are allowed to remain, — like 
old stumps in the forest, — they block 
the way to the incoming second teeth, 

154 




Crooked, carious teeth. In them danger to the whole body lurks at 
the door of the body. They poison all food and drink. 



FOR THE DOCTOR 

causing all varieties of ugly jaws. 
These cause almost unbelievable mis- 
chief through the nervous irritation 
arising from the pressure produced by 
such wedged-in or " impacted " teeth. 
We have known boys who, because of 
this nervousness from impacted teeth, 
came to be " problems " at home and 
nuisances in school, — to have developed 
lying and stealing, ultimately reaching 
the juvenile court and the house of de- 
tention. It has needed only the re- 
moval of such teeth to work entire and 
lasting reformation in such boys. 

Neglect of Tooth Brush. 

The neglect of the toothbrush is 
another reason for poor teeth. Among 
2677 mouths examined in the public 
schools of one city, there were found 
15,061 dental cavities. In 1477 of these 
mouths a toothbrush had never been 
used. Particles of food allowed to 

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WHEN TO SEND 

lodge and remain in and between the 
teeth ferment easily and cause bacteria 
to grow within the mouth. 

A recent investigation has counted 
more than one hundred varieties of 
these germs or microbes. If they are 
not attacked with the toothbrush they 
are swept down with any swallowing 
of food into the stomach and even into 
the bowels, producing many attacks of 
so-called indigestion. Even appendi- 
citis may be traced to the spread of in- 
fection to the bowel by these invading 
microbes from the mouth. 

Tartar and Decay. 

Tartar, decay or " caries " or reced- 
ing gums are frequent danger signals 
for which we must be continually alert. 
Tartar is the " every-day " name for the 
dirty green line of decomposition too 
often seen at the junction of teeth and 
gums. If it is not removed, the bac- 

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FOR THE DOCTOR 

teria produced by this filth will cause 
such irritation of the gums as to make 
them sore. Then follows the shrinking 
or " receding " from the teeth. Ne- 
glected tartar will attack the polished 
enamel of the teeth, and by producing 
the smallest possible cracks or crevices 
therein will lead the way to ultimate 
decay or caries. 

Signs of Decay. 

Common toothache may be the first 
sign of decay. Because of this one 
must not be content with the mere re- 
lieving of the child's pain by the appli- 
cation of a few drops of oil of cloves, or 
by the use of the tiny dental plaster 
over the aching gum. Either the fam- 
ily dentist or the school dentist must be 
paid an early visit and a search be made 
for the first appearance of crack or 
cavity. 

' When the boys and girls of Roch- 

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WHEN TO SEND 

ester go to Dr. Goler for work certifi- 
cates, he requires not merely evidence 
of age and schooling, but examines their 
eyes, noses, throats, and their teeth. If 
a boy has twelve decayed teeth Dr. 
Goler explains to him that good teeth 
are meant to be not only ornaments, but 
that they are to serve a purpose, to help 
digestion and maintain good health, 
thus making him an efficient worker. 
If they are put into proper condition 
he will earn good wages sooner. If the 
boy's mother protests in tears or anger, 
that her ' boy does not work with his 
teeth,' she learns what she never learnt 
at school, that sound teeth help to pay 
the rent!" 

Care of Teeth. 

Unless handicapped by extremely 
poor health, the teeth should last to the 
end of life, if properly cared for; and 

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FOR THE DOCTOR 

this care may be made a simple if faith- 
ful matter. 

They must be cleansed after each 
meal and again before retiring at night. 
For this purpose, warm water and a 
moderately stiff bristle toothbrush will 
be sufficient, although a simple tooth 
wash, or powder, or paste, is a slight ad- 
vantage. A powder made of equal 
parts of prepared chalk and orris root 
is simple, cheap and efficient. For the 
spaces between the teeth which a brush 
does not reach, the drawing of soft sew- 
ing silk, or " dental floss " through 
them, will remove the smaller particles 
of food therein lodged, thus leaving no 
favorable soil for the cultivation of bac- 
teria, that " advance army " of decay. 
Following the bedtime brushing it is 
good practice to rinse the mouth with a 
mild disinfectant " solution " — like di- 
luted peroxide of hydrogen. 



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WHEN TO SEND 



CHAPTER XVI 

DEFECTIVE SPEECH 

Defective Speech. 

The misplaced, overlapping teeth, 
described as accompanying the " ade- 
noid face," are often responsible for 
poor speech, or " defective articula- 
tion." After the adenoids have been 
removed, the straightening of the teeth 
must receive attention before progress 
will be made in the improvement of the 
child's speech. 

Imperfect Speech Caused by Imperfect Hear- 
ing. 

Imperfect speech may arise through 
a small or great defect of hearing. 
When a child cannot hear the speech of 
those around him, he cannot be ex- 
pected to reproduce it properly. Yet 
this cause is rarely considered, and such 

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FOR THE DOCTOR 

a child is more apt to be teased or 
scolded because he does not talk prop- 
erly. If there is unsuspected deafness 
at the root of the trouble, valuable time 
may be lost in neglecting to have the 
hearing tested. 

Adenoids a Cause of Defective Speech. 

Adenoids and enlarged tonsils may 
cause defects of speech, — i.e., stutter- 
ing and stammering, and, even if faults 
not so annoying as these are caused, 
many letters are pronounced imper- 
fectly. With a child so affected his 
k's are sounded as t's; his g's as d's; 
his t's are sometimes sounded as " tch." 
Should any or all of these faults be 
present, let the mother be warned by 
the adenoid " signs " we have carefully 
described, and, if they be present in 
the smallest degree, she must lose no 
time in consulting the family physician 
or a nose and throat specialist. 

11 161 



WHEN TO SEND 



CHAPTER XVII 

DEFECTS OF POSTURE 

Thus far we have considered defects 
of " special organs " or senses. There 
are general defects of the body, more- 
over, that assist in the general handicap 
of humanity, if neglected. 

A few years ago the superintendent 
of the Board of Education in New 
York City sent printed orders through- 
out the schools in that city, that the 
girls should " shift " daily their load 
of school-books, carrying them upon the 
right side of the body for one day, upon 
the left for the next, thus changing 
regularly. This was done in order to 
correct, if possible, the growing ten- 
dency of lateral spinal curvature among 
the school-children. Some authorities 
declare that one in every five girls can 
show the " twisted " spine. 

162 



FOR THE DOCTOR 

But this is not the only defect en- 
countered as we scan the pupils in the 
class-room or the bobbin-winders in the 
first large factory we enter, or any of 
the boys and girls who too early take 
their place in the " industrial " or work- 
ing army of to-day. What other de- 
fects or deformities do we find? They 
are round shoulders, flat chests, pigeon- 
breasts, bow-legs, knock-knees, and 
flat-feet. 

We need scarcely to describe them 
more than by the mere giving of their 
names. How often do we see them! 
How often do we neglect them I 

How little attention is given to the 
boy or girl sitting almost " bent 
double " over the school-book at night. 
If we do correct him, he will " straight- 
en up " for a few minutes, but in less 
than half an hour he is bent again like 
the proverbial " jack-knife." And 
though we may at last realize the 

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WHEN TO SEND 

" habit/' as we call it, we do not recog- 
nize the causes of the habit, nor the truth 
that the habit will " go farther and fare 
worse," causing the lasting deformity 
of spinal curvature. 

Causes of Round Shoulders. 

Defective vision and defective hear- 
ing, one or both, may be the cause of 
the stooping shoulders, in the effort to 
bring the poor eye and ear nearer to 
the things to be seen and heard. With 
shoulders thus perpetually bent, it will 
not be long before the next step in na- 
ture's thwarted processes follows, and 
the flexible spine will be found yielding 
to the same impulse. So it happens 
that very soon the backbone is likewise 
habitually twisted to the same side to 
which the shoulder is inclined, Hence 
arises the " lateral curvature " of the 
spine of which we are hearing so much 
in these modern days. 

164 



FOR THE DOCTOR 

Badly adjusted seats and desks in 
the school-room will produce the same 
trouble ; also badly lighted school-rooms 
and work-rooms where our boys and 
girls are employed will do the same 
thing. 

Careless habits of standing or walk- 
ing with the weight of the body thrown 
chiefly upon one side, or with the weight 
of books and bundles upon one side, 
will provoke a one-sided twist that may 
become permanent. 

How Recognize the Condition? 

How may the mother discover this 
condition? Let her undress the child, 
and, with the entire back exposed, let 
her hand " travel " or feel the length 
of the child's spinal column from the 
neck to the very tip of the backbone. 
The rather sharp " knobs " or projec- 
tions felt all along the spine should be 
fairly in the centre of the back. If in- 

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WHEN TO SEND 

stead of this they are felt at one or the 
other side of the centre, the mischief is 
probably begun. Let her look also at 
the two shoulders and the shoulder- 
blades; these should be on an exact 
level. If one is higher or lower than the 
other, this betokens the carrying over of 
the spine to one side. 

Immediately that this condition is 
detected, insist upon a doctor's careful 
examination, and be satisfied with 
nothing less. He only is the one com- 
petent to describe how far the curvature 
may have gone and how it may be 
corrected. 

Tuberculosis of the Spine. 

Instead of a lateral curve of the 
spine, there may be a bend backward, 
giving the appearance known com- 
monly as " hunch-back." This, how- 
ever, is more than a defect in posture. 
This is a bend caused by the disease 

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FOR THE DOCTOR 

and accompanying destruction of the 
separate small bones of the spine, and 
is usually a tubercular process. A 
child thus affected suffers from con- 
stant pain in the back — and great stiff- 
ness. He walks stiffly, taking short 
steps. Stooping and rising are usually 
also very painful. It goes without say- 
ing that constant medical attention is 
needed for this condition, for the spinal 
trouble will be commonly accompanied 
or followed by involvement of the hip 
(or " hip- joint disease") and of the 
knee, or the dreaded, familiar " white 
swelling." 

Flat Chest, Pigeon-breast. 

Of these deformities we have already 
spoken at length in describing the 
" adenoid " child. They may result 
also from " rickets," a disease of in- 
fancy in which the bones remain too 
soft. Because of the lack of the needed 

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WHEN TO SEND 

lime in the milk or other food given to 
the child, the " cartilage " or gristle, 
from which bone is made, fails to 
harden. The inefficient food is, in fact, 
unable to nourish any part of the body 
as it should, and all its tissues remain 
soft, flabby, and underfed. 

In such a child with therefore weakly 
acting lungs, there is little need for the 
expanding of the ribs and fleshy walls 
of the chest. Consequently the latter 
remains flat from lack of use. 

Accompanying the flattened ribs, the 
soft breast-bone, bending too easily, 
curves forward, giving the " chicken-" 
or pigeon-breast appearance. These 
are the children who are prone to de- 
velop tuberculosis later in life, because 
of the handicap with which they are 
started. Flat chests give no room for 
healthy lungs, and these organs, being 
themselves undeveloped, are not ready 
for the work nature intends for them. 

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FOR THE DOCTOR 

Bow=legs and Knock=knees. 

These deformities occur oftenest 
among the " rhachitic " or rickety chil- 
dren just pictured. In infancy their 
lack of nourishment makes them fret- 
ful and peevish. For this reason, they 
are rocked and carried and swung in 
the effort to quiet them. Too long be- 
fore they are able, the parent or nurse 
is tempted to make them stand — again 
in the frantic attempt to quiet or divert 
them. Of course the soft bones of the 
legs give way before the weight of the 
body upon them, and the inevitable 
bending so produced gives occasion to 
the " bow-leg " and the turned-in or 
" knock-knee." 

Flat-feet. 

What of the deformity known as 
flat-foot? We pride ourselves upon be- 
ing so much more knowing than our 
forbears, in that the once labelled 

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WHEN TO SEND 

" growing pains " of childhood are rec- 
ognized to-day as true rheumatic pains. 
But we are not yet wise enough for 
our day and generation, for it is more 
than possible that some of these are 
neither " growing " nor rheumatic 
pains, but are signs of hitherto unrecog- 
nized flat-foot. 

It was formerly taught that the baby 
was born flat-footed. According to a 
great deal of recent, patient investiga- 
tion, this is a mistake. The arch of a 
new-born baby's foot is really well 
formed. 

What do we mean by the " arch " of 
the foot? The foot is " built " on the 
same principle as the hand, — of many 
small bones, in order to secure ease of 
movement; but there is the difference 
between the hand and foot in that the 
latter is needed for the support of the 
entire body. To get this feature of 
support combined with the lightness 

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FOR THE DOCTOR 

possible for easy motion, the small 
bones are arranged as the span or arch 
of a bridge, thus giving us the most 
wonderful and beautiful piece of archi- 
tecture in all the world, — " the arch of 
the human foot! " 

The front part of this arch or span 
slopes downward and is about twice the 
length of the under section. " Its work 
is that of balance and shock-absorber. 
The hinder part is made up of fewer 
and larger bones, slopes backward and 
downward, and is made evidently for 
bearing w r eight." " The arch is low and 
well braced at the outer side of the 
foot,— higher but not so well built up 
at the inner side." 

" As soon as the child begins to walk, 
the inner arch breaks down, and for the 
next year and a half remains quite flat. 
During the third year the arch is slowly 
rebuilt by nature, one foot sometimes 
faster than the other, and the girl's 

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WHEN TO SEND 

faster than the boy's. When the fourth 
year is entered upon, the feet have 
nearly reached the adult type, the two 
feet are alike, and there is no difference 
between girl and boy. At the sixth year 
the adult type is fully seen and is ready 
for use." 

Perhaps this explanation will make 
it easier to understand why any general 
weakness of the whole body or any over- 
taxing of the muscles of the foot and 
leg may easily tend to " break down " 
again the bony arch of the foot if it is 
improperly or unwisely used. This will 
happen more readily if the foot is im- 
properly shod. 

Signs of Flat=foot. 

What are the symptoms of flat-foot? 
They are pains in the heel and sole of 
the foot, in the knees and thighs, in the 
hips and back. Stiffness and frequent 
complaints of weariness are likewise re- 
sults of the condition. If not corrected, 

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Blue imprint of severe case of flat-foot. 



FOR THE DOCTOR 

the nervous irritation produced by the 
constant weariness may result in a 
weakening of the entire nervous system. 

To prove whether the condition ex- 
ists, let the feet be thoroughly wetted 
and placed upon a large sheet of paper, 
thus leaving their " impression." 
Where flat-foot exists, the imprint of 
the heel and of the ball of the heel and 
of the ball of the toes is almost a contin- 
uous surface, with the inner edge show- 
ing an almost straight line in place of 
the deep curve found from a normal 
unbroken arch. 

It must be the doctor's work to de- 
cide how far damage has been done, 
and to advise means for its correction. 

If the deformity is not far advanced, 
the doctor may trust to the mother's 
wise judgment in the choice of a shoe; 
therefore we suggest that she remember 
certain principles in choosing sensible 
footgear. 
' " There should be a low broad heel, 

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WHEN TO SEND 

perhaps even " flanged " a little to give 
firmer support. The shoe should hold 
the heel firmly, with a very short flex- 
ible shank. The sole must have a 
straight inner edge with but very little 
" spring," and should be flat from side 
to side. 

" The upper should be deeper and 
more roomy at the inner side over the 
high inner arch than at the other side." 

Whenever possible, although this 
adds about two dollars to the expense, 
shoes ought to be made upon one's own 
lasts. 

With feet properly shod and better 
support thus given to the body, the en- 
tire general posture or " carriage " will 
be improved. It is easier to walk with 
head erect, shoulders squared, and chest 
high, than when one is " run down at 
the heels." Strange though it may 
seem, if one walks slouchily, one is 
tempted to act slouchily and even think 

174 



FOR THE DOCTOR 

slouchily, and the girl or boy who be- 
gins life with half-hearted, half-souled 
habits and motives will lay a poor foun- 
dation for either health or success in 
later life. 

To-day we hear much of the need of 
going back to the " simple life." Let 
us not forget that the simple life must 
needs be the " sound " life — " a sound 
mind in a sound body." 

To-day, moreover, we are hearing 
much of the co-operation or working to- 
gether along all paths of life. The 
home, the school, the playground, the 
dietitian, the nurse, the doctor, the den- 
tist, — each is helping the other. To-day 
the doctor has a wider and different 
field of usefulness than in any previous 
history of the world's work. He is 
needed more than ever to study the 
child. 

1 Who saves a child, saves a race," 
some one has said. And to this end are 

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WHEN TO SEND 

all the energies of the time apparently 
directed. " Child hygiene " is arousing 
sincere thought in every land. Depart- 
ments of child study and child hygiene 
are being provided by the city, the state, 
the nation. Just here in such work is 
the doctor a necessity. 

If, because of the wonderful advance 
that medical knowledge has made in 
late years, the doctor is needed not so 
often to " make people well," he is 
more than ever needed to prevent them 
from falling ill. In scientific words, 
the doctor is needed more to-day to 
" conserve " than to " preserve," to pre- 
vent rather than to remedy! There- 
fore, if not with the same reasons as 
our forbears, we are, with as much 
necessity as ever, to-day impelled " to 
send for the doctor." 



176 



FOR THE DOCTOR 

CHAPTER XVIII 

THE SIGNS OF MENTAL RETARDATION 

First Sign of Mental Retardation. 

First, with regard to temperament 
or disposition, mentally deficient chil- 
dren may be divided into the excitable 
and the apathetic. Care must be taken 
here not to confuse the activity of the 
excitable class with superior mentality. 
The apathetic child may be as educable 
and as able to learn as the excitable, but 
nearly always the inexpert observer will 
give the latter more credit than the for- 
mer, on the principle that a person who 
does something is brighter than one who 
does nothing. 

The Apathetic Child. 

The baby may be extremely quiet, 
therefore, with prolonged periods of 

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WHEN TO SEND 

slumber, lying passively in any position 
in which it is laid down, with almost no 
attempt to move its hands or feet, or 
its eyes. Such a baby is in special 
danger of neglect regarding its mental 
condition, for it is pretty certain to be 
called a " good baby," and the mother 
is able to " get so much done " on ac- 
count of its abnormal quietness. Later 
on, when walking time comes, the un- 
founded complacence of the parents 
will turn to dismay as they see months, 
and sometimes even years, come and 
go without their child making any at- 
tempt to take his first step. Even un- 
der such circumstances, the strange 
fatuity of fond parents, sometimes 
abetted by the family physician, will 
predict that their child will outgrow 
his present dulness and " brighten up " 
later on, possibly when he is seven years 
old; or, if not then, when he is fourteen; 
or, if that birthday comes without 

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FOR THE DOCTOR 

bringing improvement, when he is 
twenty-one. If such hoping against 
hope were not born of the best in hu- 
man nature, it would deserve unstinted 
condemnation. As things are, it must 
be condoned as ignorance for which pos- 
sibly others are more to blame than the 
parents. 

The Excitable Child. 

The very opposite to the apathetic 
baby is the excitable. Here all is agita- 
tion,— constant activity in uncoordi- 
nated, purposeless, jerky motions. This 
is the typical " cross baby," fretful, 
peevish, nervous to an unexplainable 
degree, always irritable and crying 
without cause and refusing to be paci- 
fied. Hardly has it been put to sleep 
with great effort and much rocking be- 
fore it is again awake and fretting. 
Even in sleep it does not rest quietly, 
but jerks about with fitful choreic 

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WHEN TO SEND 

movements. Such a child is more for- 
tunate in one respect than its more 
placid brother. It draws attention and 
its peculiarities demand investigation. 
Relatives and friends ask questions ; the 
family physician is consulted concern- 
ing it ; sometimes specialists are brought 
in. Unfortunately, too little informa- 
tion is usually given, and often the sim- 
ple report is made that the baby is 
" just a crying baby " and the soothing 
formula of " it will outgrow it " silences 
the parents' fears, until backwardness 
in doing the simple things of life 
awakens them to an appreciation that 
something is radically wrong. 

First Signs of Mental Retardation. 

In both classes of children slowness 
is the first sign of mental trouble. It 
probably arises from the generally 
flaccid and incoordinated muscular sys- 
tem, a marked symptom which persists 

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FOR THE DOCTOR 

during the whole life, and enters into 
every effort, from the first crude at- 
tempts at sucking, through incontinence 
of urine, slavering, with hanging lower 
lip and hypersemic salivary glands, fal- 
tering attempts at walking and contin- 
ued shuffling gait, up to the adult's 
fumbling attempts to perform the acts 
of any manual occupation. Muscular 
tone, muscular precision, co-ordination, 
" snap," vigor, dexterity, — all the little 
knacks which come so naturally to the 
normal child from the very first attempt 
to reach for the light, — are wanting in 
the defective. 

Other Signs of Mental Retardation. 

When babyhood is passed and child- 
hood begins with the first words, first 
steps, and first teeth, other symptoms 
begin to make their appearance. The 
hearing is often imperfect, as is mani- 
fested in inattention to commands or 

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WHEN TO SEND 

spoken discourse and to sounds which 
would attract the child of normal audi- 
tion. On this account, speech is de- 
layed, and when words are finally ac- 
quired they are so inarticulate that 
nobody understands what is said except 
those familiar with the child. This is 
the case long after the normal child is 
talking clearly. Speech, indeed, is one 
of the best indications of the degree of 
mentality. The natural child begins to 
talk between nine or ten months and six- 
teen months of age. Sometimes talk- 
ing may be slowly acquired, and put- 
ting words together with any mean- 
ing may be delayed until eighteen 
months or two years. This, however, 
should cause apprehension, and if, after 
an examination by a specialist, no ab- 
normality is found in the vocal organs, 
grave consideration should be given to 
the case. If speech is not begun by the 
seventh year, with no organic defect to 

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FOR THE DOCTOR 

account for it, such as some acute ill- 
ness, malnutrition, or malformation of 
vocal organs, mental deficiency is al- 
most certain to be the cause. In that 
case, training in talking is of no avail ; 
the child does not talk because it has 
nothing to express. 

Walking as a Sign of Feeblemindedness. 

Next to speaking in symptomatic 
importance comes walking. Even after 
the natural inertia of the defective has 
been overcome by a budding interest in 
things about him and a desire to imi- 
tate other children in moving about, the 
muscular incoordination which under- 
lies all his activities gives him a slouchy, 
staggering gait, with body bent for- 
ward and hands falteringly extended 
like a decrepit old man. There is a cu- 
rious atavistic return to the ape-atti- 
tude in both standing and walking. 
The body is bent forward at the hips, 

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WHEN TO SEND 

the knees are also bent, the hands swing 
low, and the shoulders droop forward. 
In movement the feet are dragged, the 
step is slow, running is an art of late 
acquirement and performed only with 
constant fear of falling, steps are 
climbed one at a time, games are only 
half entered into, and there is usually a 
general appearance of weariness un- 
natural to boisterous childhood. When 
the defective is excited, and more com- 
monly in the case of the excitable type, 
a nervous flightiness, with a disposition 
to wander aimlessly from one thing to 
another, exhibits itself. 

Playing as an Indication of Subnormality, 

In play, the best and truest expres- 
sion of all there is in childhood, the 
weak-minded unfortunate shows his 
preference for mates much younger 
than himself. With them he feels some- 
what at home. With those of his own 

184 



FOR THE DOCTOR 

age he is hopelessly handicapped, and 
becomes either the petty servant of his 
comrades or else the butt and sport of 
the unfeeling ones. Oftentimes his 
play with others is made up largely of 
meaningless chatter and silly laughter, 
with peculiar, excitable movements, 
like jumping up and down, screaming 
at intervals, waving his arms, and mak- 
ing grimaces. 

Fatigue. 

In attempting to learn anything new, 
whether it be a game or a lesson or the 
simple acts of dressing, washing, or 
combing his hair, he very quickly gives 
evidence of fatigue. He is prone to 
give up, and turn his flighty and half- 
given attention to something else. If 
he is restrained from wandering and 
compelled to fix his mind upon the task 
in hand, further fatigue symptoms ap- 
pear in nervousness of the hands, jerky, 

185 



WHEN TO SEND 

foolish little motions, redness of cheeks, 
brightness of eyes, followed, if further 
pressure is brought to bear, by a tremu- 
lous excitement, which communicates 
itself to nearly the whole body and ends 
with tears and sobbing and complete in- 
ability to do anything whatsoever. To 
push a child to such an extreme is an 
act of folly, in parent or teacher, im- 
possible to criticise too severely. Yet 
it is often done, under the blindly ig- 
norant notion that the child can if it 
will, or that it is lazy, because the un- 
informed adult measures the child's 
powers by that of a normal child, and 
does not understand that this very in- 
ability to stick to a task is the first inti- 
mation of mental deficiency. 

Lack of Attention. 

If the feeble-minded of any grade 
could only pay attention, and pay at- 
tention long enough, he could learn 

186 



FOR THE DOCTOR 

anything as well, if not as fast, as one 
with a brilliant mind. Attention, how- 
ever, is the adjustment of some organ 
of sense — usually the eyes — to some 
stimulus or upon some point of interest, 
and depends upon the ability to coor- 
dinate and keep certain muscles in a 
certain tension. This, as has already 
been said, is a fundamental defect with 
the weak-minded. Therefore, fatigue, 
as manifested in flightiness or inatten- 
tion, is a marked and usual characteris- 
tic of the class. In early childhood it 
shows itself in complete indifference to 
the toys ordinarily objects of intense 
desire to a normal child. The healthy 
baby, even, will strain and grasp and 
kick to get at some bright-colored ob- 
ject held before its eyes. The little 
child will run after any new object 
rolled or thrown before it. Curiosity 
prompts attention, and attention 
prompts ready and vigorous movement 

187 



WHEN TO SEND 

toward the interesting toy. Not so 
with the defective. Stolid indifference 
is the reward of any one who tries to 
interest it with the brightest, newest, 
shiniest toy. If the ball is rolled before 
it, it stares with blank or inquiring face, 
but does not make any effort to follow 
it. Only by the most persistent and 
painstaking devices is attention 
aroused, and then to be held but for 
a moment before either fatigue sets in 
or some other equally stimulating 
thing attracts, or stolid indifference 
again closes down like a pall upon the 
momentarily lighted face. 

Lack of Imitation. 

Under such circumstances it is not 
surprising to find that imitation is at 
first almost wholly absent, and, later 
on, in childhood, at the school-age, it is 
but lame and feeble in comparison with 
the healthy and ready mimicry of the 

188 



FOR THE DOCTOR 

vigorous boy or girl. In a family with 
many other children, the commonest 
acts of every-day life must be labori- 
ously taught, instead of being sponta- 
neously imitated. Learning to dress 
costs as much time and labor as learn- 
ing to write with a normal child. Other 
daily duties are the same. Washing the 
face and hands, combing the hair, put- 
ting on shoes, tying strings, ribbons, or 
any of the thousand and one simple acts 
learned unconsciously by the rest of the 
family are sources of endless worry and 
much practice to the helpless ones. 

These are general characteristics of 
the defectives. They are open to in- 
spection to any eye and can be watched 
daily in the home or in the school. No 
special skill is required in their observ- 
ance. Their significance must be un- 
derstood, and it must not be asserted 
that their causes reside in the mere un- 
willingness of the afflicted one, but they 

189 



WHEN TO SEND 

must be treated as symptoms having a 
sinister meaning for the future mental 
accomplishments of their possessor, to 
be overcome by the most patient, skil- 
ful, and persistent training by teachers 
fitted both by nature and by experience 
for the delicate task. 

Stigmata or Physical Marks of Feeble Minds. 

Passing now from these general 
characteristics, we will turn our eyes 
in a little closer scrutiny upon the 
various organs of the defective one, 
and see how they may differ in a typi- 
cal case from those of a normal human 
being. In the study of stigmata, it 
must be remembered that probably no 
one case will present all the signs of 
degeneration. Neither, on the other 
hand, should any person be adjudged 
subnormal because of the presence of 
even a few of the degenerative marks. 
In fact, it would be almost a perfect 

190 



FOR THE DOCTOR 

specimen of the genus homo who could 
submit to a minute inspection and es- 
cape without a mark against him. But 
it takes more than one swallow to make 
a summer and more than one stigma to 
make a degenerate, mental or moral. 
At present there is a distinct reaction 
against the theories of Lombroso and 
his school, who taught, but a short time 
ago, that the mentality and the morality 
of men should be read from bodily idio- 
syncrasies as from the pages of a book. 
Later investigations by Dr. Travis 1 
and others tend to modify the extreme 
views of the stigmatic school, and to 
place less emphasis upon the shape and 
size of craniums, and the position and 
development of ears, eyes, nose, hands, 
and other organs. A man with silky, 
curly hair and delicate, tapering fingers 
may have a few attributes for the career 
of a successful pickpocket, but it would 

^he Young Malefactor. Thomas Travis, 1908. 
191 



WHEN TO SEND 

be assuredly preposterous to arrest 
every man born with such curly hair 
and slender fingers. 

In fact, it is safe to say that physical 
signs of degeneration, taken by them- 
selves, are most untrustworthy evidence 
upon which to base predictions of intel- 
lectual or moral accomplishments. 
Taken in consideration with conduct or 
character already revealed in a long se- 
ries of actions, all tending downward 
or toward constantly increasing relative 
retardation, in any child, shown in fall- 
ing farther and farther behind his com- 
panions in school grades, for example, 
stigmata, or congenital physical abnor- 
malities, have a most decisive purport 
for deciding the causes of such tenden- 
cies or trends of conduct. A micro- 
cephalic skull, or one smaller in girth 
than the average, signifies nothing in 
itself regarding mental endowment. 
Men with such reduced brain spaces are 

192 



FOR THE DOCTOR 

found both in asylums for dements and 
in professors' chairs. Only when the 
small head is found upon the shoulders 
of some one with a record for extreme 
slowness, distinct inability to perform 
certain common mental tasks, like men- 
tal arithmetic, or with a record of per- 
sistent and uncalled-for criminal acts, 
does it mean much. 

The Skull. 

With these words of warning, we will 
give a few points to be especially noted 
in the examination of a backward child 
for incurable mental deficiency. The 
shape of the skull is a prominent char- 
acteristic in many typical cases of im- 
becility. It may be too small in girth, 
measured round just above the eyes and 
ears, and compared with height, weight, 
and age. For the average girth, or 
standard, the " Manual of Physical 
Measurements," by William W. Hast- 

13 193 



WHEN TO SEND 

ings, published in 1902, by the Y. M, 
C. A. Training School at Springfield, 
Mass., or similar tables, can be con- 
sulted; though it must be remembered 
that a slight deviation in this one di- 
mension is not final, and that typical 
microcephalic imbecility is usually ac- 
companied not only by a small head, 
but also one which slopes from the fore- 
head to a point or apex over the ears, 
and then drops suddenly in a nearly 
perpendicular line to the neck, thus giv- 
ing a somewhat flattened back or occi- 
put. From above, such a head presents 
a beautiful oval, with its widest portion 
about over the ears and narrowing to- 
ward the forehead. 

Opposite to the microcephalic is the 
hydrocephalic skull, or the one with 
" water on the brain." Here again, all 
hydrocephalics are not feeble-minded. 
When the condition is found with 
feeble-minded conduct, it argues de- 

194 



FOR THE DOCTOR 

cisively that the fluid which has col- 
lected in the brain-cavities, or ventri- 
cles, or between the brain coverings 
called meninges, has also brought about 
degenerative changes in the organ it- 
self. This may be due to the pressure 
from within, which has caused the bony 
skull to bulge over the eyes until, in ex- 
treme cases, the patient becomes so top- 
heavy he is unable to walk, In milder 
cases the bulging shape of the cranium 
and abnormal girth, measured with the 
tape-line, will usually fix the cause of 
the trouble. 

Pressure on the Brain. 

It might be noted, as a matter of 
passing interest, that the " pressure on 
the brain," so often invoked by those 
unacquainted with the true causes of 
idiocy, is almost always alleged for the 
explanation of dulness in the micro- 
cephalic child, but almost never in the 

195 



WHEN TO SEND 

case of the hydrocephalic. The opposite, 
if anything, is true. If there is any 
abnormal pressure at all upon the 
brain, it occurs with the big-headed and 
not with the little-headed sufferers. In 
neither case is there any severe pres- 
sure, for it is the law of growth that 
hard structures will conform themselves 
to softer parts of the same organism. 

Rickets. 

Beside these two common sizes and 
shapes in skull formation, another must 
be placed, probably met with more fre- 
quently, but possibly not so often ac- 
companied with mental aberrations. It 
is called the " box-shaped " skull, or the 
rhachitic skull, because it indicates the 
presence of rickets in babyhood, or at 
least some severe fault of nutrition. 
The skull is brachycephalic, short and 
broad, with a wide, flat forehead, two 
rounded corners, one above each eye, 

196 



FOR THE DOCTOR 

two more corners at the occipitoparie- 
tal points and the flattened occipital 
surface, or with the relatively large dor- 
sal protuberance which seems to be plas- 
tered upon an otherwise flat surface. 

The " box-shaped " skull does not in- 
dicate mental deficiency because of the 
malformed brain underneath, but be- 
cause of the malnutrition, marasmus, 
or rickets suffered at one time by the 
posessor of such a head, and the conse- 
quent non-development of nerve organs 
along with the general retardation of 
all parts of the body. A box-shaped 
skull, therefore, usually accompanies 
lack of all-around physical growth, un- 
der-size, under-weight, deformed ribs 
bent at the sternum into the so-called 
" rosary," Harrison's groove, en- 
larged epiphyses, and general under- 
tone. If such symptoms have been 
largely overcome by later feeding and 

197 



WHEN TO SEND 

care, the brain development has usually 
progressed correspondingly. 

The Ears. 

The study of defective ears alone 
would make a volume. One specialist 
enumerated thirty-eight distinctive stig- 
mata of the auditory organ which be- 
trayed lowered mentality in varying de- 
grees. Such minute study of degen- 
erate marks, even from a scientific point 
alone, are always open to question, and 
for the clinician have no practical 
value. The grosser and more striking 
variations from type, exhibited in the 
size, shape, position, and development 
of the ears in any suspected case of de- 
generacy, have some significance, and 
should be given their due proportion of 
weight in the final decision regarding 
the mental status of their possessor. 

The ear taken as a whole may be de- 
formed, — large, twisted, or rudimen- 

198 



FOR THE DOCTOR 

tary. The lobules are special sources 
of defect, being rudimentary, absent, 
or adherent. The pinnae, the helices, 
and the anthelices are often faulty and 
undeveloped. Darwinian tubercles 
may be present, sometimes several upon 
the helix of each ear, but are not any 
more frequent perhaps than with nor- 
mal people. The position of the ear, 
looking at the head upon the lateral as- 
pect, frequently appears to be situated 
farther back than it should be. This 
often arises from the fact that the skull 
is flattened in the occipital region, as in 
the cases of microcephaly and rickets. 

Nose. 

After the ears comes the nose in di- 
agnostic importance. Its shape and 
development are of especial signifi- 
cance. The commonest structural ab- 
normalities are those associated with 
adenoids. Where adenoids have devel- 

199 



WHEN TO SEND 

oped, the nose widens and thickens at 
the bridge without any marked depres- 
sion of the bridge, while at the same 
time the alse seem to cease their growth 
and remain infantile, without clear-cut 
chiselling. This gives a " baby " ap- 
pearance to the whole nose. In distinc- 
tion from the ordinary adenoid nose, 
the nose of the feeble-minded is usually 
flattened at the bridge, broad at the 
nostrils, with wide alee, the whole ap- 
pearance being coarse and undeveloped. 

The Mouth. 

In general the mouth belongs to one 
of two types, — the lips are either thick 
and coarse or thin and immobile. The 
palate is misshapen, high-arched, keel- 
shaped, and V-shaped. Frequently the 
gums are much swollen and spongy. 
The tongue is either pointed or thick, 
fissured, and rough. The teeth are fre- 
quently decayed, irregular, and often- 
times the normal number do not ap- 
200 



FOR THE DOCTOR 

pear. In the case of amentia due to 
syphilis, the teeth present the peculiar 
peg-shaped and notched forms, known 
as Hutchison's teeth. In the lower 
grades of mentally deficient children 
sialorrhoea, or drooling, is very common. 
The corners of the mouth are frequently 
sore. 

The Hands. 

The hands are powerless ; the prehen- 
sion is almost always very feeble; the 
fingers are thick, clubbed, and the nails 
brittle, rough, and corrugated. Coor- 
dination is extremely undeveloped and 
manual skill very difficult to be 
acquired. 

The Skin. 

Probably one of the first signs of de- 
generacy noticeable upon the presenta- 
tion of a feeble-minded child is the gen- 
eral condition of the skin. Without 
particular attention and with only a 
201 



WHEN TO SEND 

casual glance, even the uninitiated ob- 
server recognizes some peculiarity 
about it. The integument is usually 
coarse and flabby, there is the prone- 
ness to eczema, rupia, and other cuta- 
neous diseases in general. Often there 
is a peculiar pungent odor coming from 
the skin, not due wholly to lack of bath- 
ing. Vegetable and animal parasites 
find an especially congenial soil in the 
skin of the degenerate, and will some- 
times find permanent abiding places 
upon the body of the feeble-minded 
child, when they will not attack, or will 
be speedily eliminated from, his nor- 
mal brothers and sisters in the family. 

Degrees of Feeble=mindedness. 

The above descriptions of the various 
organs and their stigmata will serve to 
distinguish mental deficiency in gen- 
eral. When this condition is diag- 
nosed, however, the work has just be- 

202 



FOR THE DOCTOR 

gun. The next process is to decide the 
class to which the dement belongs. 
While there are many degrees of amen- 
tia, and the extremes of the highest 
and the lowest mentality stand out with 
marked distinctiveness, yet the degrees 
merge into one another, in stages so 
slightly separated from those above or 
below, that the demarcations are ex- 
ceedingly hard to discern. In other 
words, the gradations between pro- 
found idiocy and high-grade imbecility 
are not steps nor stages, but, if graph- 
ically indicated, should be shown with 
a curve without a break. In nature, 
mentally defective children are not 
graded. Therefore any classification 
that is made must be looked upon as ar- 
tificial and to some extent arbitrary. 

Use of Classification. 

Though this is true, it must not be 
thought that classification is merely 

203 



WHEN TO SEND 

theoretical or academical, and without 
practical value. It is extremely neces- 
sary to classify a child in order to give 
him the proper kind of training. For 
the methods of training, though not the 
principles, change with degrees of de- 
generacy. Thus, a high-grade imbecile 
should be educated by methods differ- 
ent and far more rapid than those ap- 
plicable to a low-grade imbecile. 

More than this, the ultimate extent 
to which the training can be carried 
and the intellectual results which will 
accrue to the subject from it are to a 
large extent predictable from the de- 
gree of mental deficiency diagnosed. 
Hence, for prognostic purposes, classi- 
fication is also highly necessary. It is 
of supreme importance, also, where the 
problem of cost, the length of time pos- 
sible to devote to it, are final for decid- 
ing what shall be done with any par- 
ticular child. Theoretically, of course, 

204 



FOR THE DOCTOR 

and under ideal conditions where pro- 
vision was made for every defective, 
such practical considerations as the last 
would not be important, but under the 
present conditions they often become 
decisive. 

With these words of introduction we 
will give a few indications of the differ- 
ent stages of idiocy, idio-imbecility, and 
imbecility, following the educational 
classification already laid down. 

Signs of Idiocy, Profound and Superficial. 

Beginning with idiocy, since that 
type is marked in its symptoms and 
comparatively simple and easy of diag- 
nosis, we will proceed to the higher 
stages. Idiocy is sub-classified as pro- 
found and superficial. With the pro- 
found idiot, with the apathetic disposi- 
tion, there is no speech, no sound, no 
movement, and, as Dr. Barr sums it up, 
he is " just a breathing mass of help- 

205 



WHEN TO SEND 

lessness." The excited idiot, on the 
other hand, may utter bleating cries, 
with constant movements, such as roll- 
ing the head and twisting the body and 
making rhythmic motions of his eyes 
or his fingers. These characteristics are 
sufficient to mark this stage, one, prob- 
ably, with which the public very seldom 
comes in contact. 

Just above the profound idiot comes 
the superficial. In the case of the 
apathetic kind, mutism is the rule. 
Wants are made known by signs, by 
inarticulate cries. Often the limbs are 
wholly or partially paralyzed and the 
extremities are cold and livid. When- 
ever the idiot is able to walk, his steps 
are those of tottering infancy; usually 
he sits all day in idleness, dribbling 
saliva or blowing bubbles from his 
mouth, taking almost no notice of 
things going on about him. 

His excitable brother is an imp of 

206 



FOR THE DOCTOR 

mischief, with a violent temper, wilful, 
restless, and always in motion, curious 
to a degree, testing everything with his 
fingers and tongue, and swallowing 
everything that he can get into his 
mouth, including stones, rags, sticks, 
and garbage of every description. His 
speech is delayed for many years, and, 
when finally acquired, consists of noth- 
ing more than broken sentences of 
monosyllable words, accompanied by 
harsh, inhuman cries and gestures. His 
gait is an unsteady shuffle, with a drag- 
ging, faulty step, knees " jack-knifed " 
and body bent forward, reminding one 
of the postures of an ape. 

The Idio=imbecile. 

Above the idiot and below the imbe- 
ciles come the idio-imbeciles. They 
share the physical characteristics and 
habits of the idiot with something of the 
limited character of the imbecile. 

207 



WHEN TO SEND 

Again the dragging, faulty step and 
lurching gait are met, though much im- 
proved over the idiot's. Clumsiness is 
one of their marked characteristics, and 
exhibits itself because of increased mus- 
cular power yet uncoordinated. Their 
speech is also limited, and they make 
free use of signs, often accompanied by 
a senseless chatter and silly laughter. 
The silly humor often changes into sud- 
den and unprovoked anger. The skin 
is coarse and often peels off in large 
flakes ; poor circulation, accompanied 
by sores, ulcers, chilblains, and frost- 
bites. 

The Imbeciles, Low-grade. 

In the low-grade imbecile we find the 
stigmata are still marked. Speech is 
usually present, but articulation is de- 
fective; the vocabulary is limited and 
meaningless chatter very common. 
Reading and writing are difficult and 

208 



FOR THE DOCTOR 

almost impossible to acquire. Often 
the simplest and most ordinary occupa- 
tions of making a living require all the 
ability of this grade, and beyond this, 
undirected, he will probably never pro- 
ceed. His life, therefore, should be 
spent in a colony, doing those things 
for which he is best fitted under the 
most careful direction and supervision. 

Middle=grade Imbecile, 

One remove higher is the middle- 
grade imbecile. Here we begin to note 
for the first time an approximation to 
the normal, a mentality more human 
than animal. In comparison with the 
grades below, the middle-grade imbe- 
cile is mild and equable in temper. He 
readily takes in suggestions offered and 
is almost wholly directed or influenced 
by his environment and companions. 
Hence, if left to himself, he readily 
learns all the bad habits of men with- 

- 14 209 



WHEN TO SEND 

out acquiring their more difficult vir- 
tues. His vision and hearing are often 
defective. In school he is dull; his at- 
tention is feeble; he is easily fatigued, 
and, when pressed beyond his endur- 
ance with any new tasks, becomes ex- 
cited, confused, and completely help- 
less, showing his state of mind by in- 
ability to proceed with his tasks, and 
staring with fixed eyes and red-hot 
cheeks before him, or else breaking out 
in anger or giving way to tears. He 
cannot advance beyond the simplest 
primary work in books, though he may 
be interested in nature and in manual 
training. He is able to talk compara- 
tively well, though defects in articula- 
tion are very common. His walk and 
his movements in general are fairly 
well coordinated and, in the better class, 
depart very little from the normal. 
There is, however, about him a general 
air of vacuity and listlessness which 
210 



FOR THE DOCTOR 

marks him out immediately from the 
alert, precise, normal child. 

High=grade Imbecile. 

Hardly to be distinguished from the 
normal child is the high-grade imbecile, 
and here the diagnosis is specially diffi- 
cult and can be made only by careful 
and sometimes prolonged observation, 
though it is easy to distinguish him from 
the normal child who makes good 
progress in school. Between him, how- 
ever, and the dull or backward school- 
child, there are, on the surface, no spe- 
cial differences. It is only by the 
closest investigation of his heredity and 
life history that certain ancestral neu- 
rotic tendencies and accumulations of 
little departures from the normal will 
finally decide the case. 

Idiot Geniuses. 

It is especially to this class of high- 
grade imbeciles, and to some extent 
211 



WHEN TO SEND 

middle-grade imbeciles, that the idiot 
savants belong. These dements often 
show the most remarkable talent in one 
or other particular direction. This 
very frequently takes the form of some 
manual dexterity, like drawing, wood 
carving, or carpenter work. Some- 
times music claims their genius and 
they accomplish wonders in a short 
time. Mathematics, also, attract some, 
and the " lightning calculator " of pub- 
lic exhibition frequently belongs to this 
class. It is on account of such items 
that often the family gives an account 
of a precocious babyhood, or of bright 
things said and done, of wonderful 
memories for dates, numbers, and iso- 
lated facts, coupled with a complete in- 
ability for systematic recollection or the 
assimilation of ideas gathered from 
books or abstract studies. Unless such 
high-grade imbeciles are carefully 
212 



FOR THE DOCTOR 

trained in habits of labor and placed in 
an environment where they will not 
come into competition with normal men, 
they are likely to lose one job after the 
other and finally to drift into the vaga- 
bond or ne'er-do-weel class. 



213 



PART V 

WHAT TO DO BEFORE THE DOCTOR COMES 



CHAPTER XIX 

WOUNDS 

Helpful as it is to know just 
" when to send for the doctor," it is at 
times vitally important to know what 
to do before the doctor arrives. 

The home, the school-room, and the 
workshop are, equally, the occasional 
scenes of accidents and injuries, — 
when unskilled aid, if accompanied by 
good judgment, common sense, and 
prompt care, may do much to relieve 
suffering and even save life. The fac- 
tory, the trolley-car, and the automo- 
bile are growing increasingly to be the 
foes of safe existence. Each and all 
collect, almost daily, their toll of hu- 
man life. Therefore, because " fore- 
warned is forearmed," it will not come 
amiss to be prepared for emergencies. 

217 



WHEN TO SEND 

Incised Wounds. 

How shall we care for ordinary 
wounds inflicted by inconsiderate 
knives, razors, and common tools? 
Sharp cutting tools make a " clean " 
cut, or so-called " incised " wound, 
which is accompanied by " free " or 
copious bleeding. This must receive 
attention at once. 

Wash such a wound with soft, clean 
muslin or linen, or, better than either, 
cheese-cloth or butter-cloth, in very hot 
water that has been boiled for five or 
ten minutes. Old flour-bags and salt- 
bags that have been washed repeatedly 
into " softness " are likewise excellent 
for these emergencies. It is a wise plan 
to keep a stock of such material in sup- 
ply, cut into generous-sized squares, 6 
inches by 6 inches. 

Hot Salt Solution. 

After the bleeding has stopped, 
then, with perfectly clean hands and 

218 



FOR THE DOCTOR 

clean fingers, attempt to bring the 
edges of the wound together, holding 
them in place by a " compress," or pad, 
or pile of these soft clean pieces of 
cloth folded into smaller squares, hav- 
ing first wrung them in very hot salt 
water (one teaspoonful of table salt to 
one pint of boiling water). 

The compress must be kept in place, 
over the wound, by a firm, clean ban- 
dage of muslin, from one to three 
yards in length, and from one-half inch 
to three inches in width. The size of 
the bandage will depend upon the loca- 
tion of the wound. 

Lacerated Wounds. 

The wound inflicted by a dull in- 
strument, such as a nail, club, stone, or 
brick, will have " ragged," not " clean " 
edges. Because of this, there is less 
possibility of uniting the edges of the 
wound for perfect healing. 

Under these conditions, first cleanse 

219 



WHEN TO SEND 

the wound, as directed above, with hot 
water (previously boiled). Next pro- 
tect it with the compress of small 
squares of clean cloth wrung in the hot 
salt solution described above, and, last 
of all, apply a firm bandage. 

Punctured Wounds. 

Wounds inflicted by splinters, fish- 
hooks, and the like are serious because 
fragments of these may be imbedded 
in the skin or deeper tissues. Bad 
enough of themselves, they are com- 
monly also dirty, and thus carry " in- 
fection " into any wound, however 
small or insignificant it may appear. 

Antiseptic Poultice. 

Consequently, after the thorough 
cleansing of the wound and the abso- 
lute removal of every last fragment of 
splinters, hook, or nail, it is a good pre- 
caution against infection to make use 
of the modern " antiseptic poultice," 
220 



FOR THE DOCTOR 

until the doctor comes. This consists 
of (a) a compress of folded squares of 
cloth (prepared as directed), soaked in 
hot salt solution (one teaspoonful of 
table salt to a pint of boiling water). 

(b) Over the compress place a layer 
(one inch thick) of clean absorbent 
cotton wrung in the same salt water. 

(c) Upon this use a compress of soft, 
dry folded squares of cloth and a half- 
inch layer of dry, clean absorbent cot- 
ton, (d) Cover the entire dressing with 
clean " paraffin," or waxed paper (an 
excellent and cheap substitute for oiled 
muslin, oiled silk, and thin rubber tis- 
sue). Lastly, confine all by a firm 
clean bandage of suitable length and 
width. 

Insect Stings. 

Insect stings make painful wounds, 
sometimes out of all proportion to their 
size. The " old-fashioned " homely ap- 
plication of mud is not to be despised 
221 



WHEN TO SEND 

for such a catastrophe. If this is not 
at hand, " hartshorn " or water of am- 
monia, and, similarly, spirit of cam- 
phor, will relieve the pain markedly. 

Bleeding. 

The management of bleeding calls 
for the exercise of intelligence. It will 
be necessary, for instance, to decide 
whether the bleeding vessel be an ar- 
tery or a vein. 

Arterial Bleeding. 

From a cut artery the blood will 
come with considerable force, in " jets " 
or spurts. To stop the flow, find the 
" route " or " line of travel " of the ar- 
tery that is wounded, and make a firm, 
steady pressure, with one or both 
thumbs upon it, between the wound and 
the heart. We will give some familiar 
" landmarks " whereby it will be possi- 
ble to find the vessel's route. 

This thumb pressure is the best 

222 



FOR THE DOCTOR 

means, usually, of checking a flow of 
blood, unless it be extraordinarily free 
and the vessel too deep to find easily. 
In such a case, place between the folds 
of a large clean towel, or handkerchief, 
a smooth stone, or a potato, as an extra 
compress. With the handkerchief 
around the limb and the " compress " 
directly upon the artery between the 
wound and the heart, place a stick or 
cane, or ruler, between the handkerchief 
and the skin opposite the compress, 
twisting it firmly and forcibly until the 
bleeding stops. Upon removing the 
stick, keep the pad of stone or potato 
in place for half an hour, to make sure 
of no return of the flow. 

Bleeding from a Vein. 

When a vein is wounded, the flow of 
blood is not in spurts, but in a steady 
stream and without force. To check 
it, remove at once all confining bands, 
garters, or skirt strings between the 

£23 



WHEN TO SEND 

wound and the heart; next raise the 
injured part of the body and apply a 
compress, made as described above, di- 
rectly upon the injury. 

Capillary Bleeding. 

For bleeding from the smallest ves- 
sels of the body, — the tiny hair-like 
tubes that course through the skin of 
the fingers, the scalp, the toes, the lips, 
the nose, — squares of clean cheese- 
cloth or muslin wrung in very hot 
water, or in ice-cold water, and held 
in place over the wound, will stop the 
flow speedily. 

Beware of the old remedies of cob- 
webs and of alum. These are apt to 
prevent clean healing of wounds. 

Bleeding from the Mouth. 

Should this arise from the cavity of 
a tooth, powdered alum may be used 
here in safety, to check the flow. 
Finely cracked or chipped ice (chipped 

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FOR THE DOCTOR 

with a clean hat-pin) may be packed 
into a cavity for the same purpose. 

Bleeding from the Nose. 

To check nose-bleed until the doctor 
comes, place iced cloths or cold-water 
cloths at the back of the neck or at the 
bridge of the nose. If neither of these 
stops the flow, a rubber finger-cot, 
thoroughly cleansed in salt water, may 
be put into the nostril that is bleeding, 
and then filled with finely cracked ice. 

Bleeding at the Neck. 

To stop a serious flow of blood from 
a wound in the neck, find the muscle 
that " stretches " from the hard bone 
behind the ear to the front end of the 
collar-bone. Along the edge of this 
muscle in the very middle of the neck, 
make firm and steady pressure with one 
or both thumbs. Should these grow 
very " tired," a compress may be made, 
as before directed, of tiny pads or piles 

15 225 



WHEN TO SEND 

of small squares of clean muslin; be- 
tween the various folds, place firm pads 
of clean absorbent cotton. Such a com- 
press, though home-made, will be very 
effectual. 

Bleeding from Upper Arm or Shoulder. 

To stop the flow of blood in a wound 
of the arm or shoulder, make firm pres- 
sure with one or both thumbs, about 
two inches from the breast-bone, and 
against the first rib, which is behind the 
collar-bone. 

Bleeding in Forearm or Hand. 

To stop bleeding in a wound of the 
hand or forearm, bend the forearm 
firmly upon the arm, and make pres- 
sure at the bend of the elbow with the 
compress of muslin and cotton. 

Bleeding at the Thigh. 

To check the flow of blood in a 
wound of the thigh, make firm pressure 

226 



FOR THE DOCTOR 

with the two thumbs or a compress, 
about six or eight inches below the 
groin, toward the inner side of the 
thigh. 

Bleeding from the Leg. 

To check bleeding in a wound of the 
leg, bend the leg firmly upon the thigh, 
and make pressure with a firm com- 
press behind the knee. Occasionally 
bleeding from wounds in thigh and leg 
may be so great that the only effectual 
pressure will be that made by the home- 
made " tourniquet " of folded towel and 
stone or potato pad, with the twisting 
of the stick, as described above. 

Bleeding from the Foot. 

Bleeding from a wound in the foot 
can be controlled by a compress placed 
between the inner ankle and the heel. 



227 



WHEN TO SEND 



CHAPTER XX 

BURNS AND SCALDS 

Slight Burns and Scalds. 

Burns and scalds are among the 
most frequent injuries at home and in 
the shop. When only redness of the 
skin is the result, we speak of the burn 
as " slight." In such cases the homely 
remedies of dusting dry starch or bak- 
ing soda, or of covering the burned part 
with lard or sweet butter, are all good. 
Better than any of these is the familiar 
mixture of equal parts of linseed oil 
and lime water, known to workmen all 
over the globe as " carron oil." 

Extensive Burns. 

When the burning has been so severe 
as to destroy the skin or to produce 
deep or large blisters, it is regarded as 

228 



FOR THE DOCTOR 

an " extensive " burn. In caring for 
such an injury before the doctor sees 
the sufferer, attempt at first to cut the 
clothing, with scissors, as close as pos- 
sible to the injured tissues. Prick all 
large blisters at their lowest corners, 
with a clean, new needle. With both 
of these precautions taken, the wounds, 
or burns, are ready for " dressing." 
This will consist of soft clean muslin 
cloths saturated with the mixture of 
linseed oil and lime water; over these 
place one or two layers of waxed or 
"paraffin" paper; upon this put a 
layer of clean cotton batting, and lastly, 
over all, place a comfortable, clean, 
loose bandage of muslin or soft flannel, 
its length and width depending upon 
the portion of the body for which it is 
required. 

In extensive burns, at the same time 
that one or two attendants are apply- 
ing the " dressing," others will give 

229 



WHEN TO SEND 

needed attention to the stimulation or 
the care of the strength of the sufferer. 
The injury may be so severe as to pro- 
duce deep " shock." For this it is 
necessary to surround the patient with 
hot bottles, or hot plates or bricks. Let 
him be covered with light blankets and 
given black coffee, if he can swallow. 

Burns with Acids. 

Certain strong corrosive acids pro- 
duce ugly burns; among them are mu- 
riatic acid, oil of vitriol, carbolic acid, 
aqua fortis. Under such conditions the 
use of baking soda, magnesia, chalk, or 
lime " dusted " thoroughly upon the 
burn will relieve pain until proper medi- 
cal aid is obtained. 

Burns with Alkalies. 

Painful burns are often produced by 
caustic soda and potash, strong am- 
monia, lye, and quicklime. For such in- 

230 



FOR THE DOCTOR 

juries the use of vinegar and water, 
lemon juice, or olive oil (even hard 
cider is quoted by one authority) will 
relieve suffering until the doctor 
arrives. 

Sunstroke or Heat-stroke. 

Heat may be disastrous in other 
forms than those described above. Dur- 
ing the progress of many a heated term, 
toll is often paid in human life, es- 
pecially among the weak, the very aged, 
and very young babies. 

In a truly typical condition of sun- 
stroke, what is the appearance of the 
sufferer? There will be seen a flushed 
face and reddened eyes, and the skin 
will be hot and dry. Dizziness, faint- 
ness, and headache will be experienced. 
Lose no time in removing the patient 
to a cool place in the fresh air and shade. 
At once loosen all clothing at the neck, 
waist, and wrists, and put wet towels 

231 



WHEN TO SEND 

or bags of cracked ice at the back of the 
head and along the spine. If these can- 
not be obtained, apply the coldest water 
possible, with a sponge, or even with a 
" watering pot." Should the heat of 
the body be intense, the patient may be 
wrapped in cool, wet sheets, taking care 
to counteract depression or " shock " 
by giving black coffee or aromatic am- 
monia (twenty to thirty drops in a 
wineglass of water), or two teaspoon- 
fuls of brandy in hot milk. 

Frost=bite. 

At the opposite end of the thermom- 
eter we may find injuries quite as pain- 
ful as those produced by heat. Frost- 
bites are not uncommon. 

If cold has been prolonged and se- 
vere enough to cause thorough freezing, 
the sufferer's limbs become white and 
stiff. The tips of the toes, fingers, and 
nose may appear spotted and pur- 

232 



FOR THE DOCTOR 

plish, — not unlike bacon in aspect. The 
deeper the color the greater the cause 
to fear gangrene as the termination of 
the injury. Under no consideration is 
such a patient to be taken near warmth 
of any kind. Keep him in a cool place 
for at least two hours, and do not allow 
him to sleep. Rub the body, a portion 
at a time, with cold water, or snow, or 
snow-water. Wrap the parts most in- 
jured in cold-water cloths, and use gen- 
tle (never violent) rubbing with the 
hand, as the body becomes less stiff. 

As soon as the sufferer can swallow, 
hot milk or beef tea may be given, to 
coax the inner, vital warmth of the body 
into persistence. 



WHEN TO SEND 



CHAPTER XXI 

UNCONSCIOUSNESS 

Fainting. 

Fainting is the loss of consciousness 
which is caused by a sudden slowing of 
the heart's action and the consequent 
" calling off " of the blood supplied to 
the brain. It may result from great 
pain or grief, sudden fear and fright, 
or even joy; bad air, great loss of blood 
from any part of the body, — any or all 
of these may cause fainting. The vic- 
tim grows pale, cold, clammy, and 
dizzy. Roaring in the ears and loss of 
sight are both followed by lack of 
consciousness. 

The first step in caring for such an 
emergency, if medical aid is not at 
hand, is to clear away, at once, the 

234 



FOR THE DOCTOR 

smallest suspicion of a knot of inter- 
ested by-standers. Remove the patient 
to the neighborhood of pure air and put 
him on his back, with the head slightly 
lower than the body. Loosen every ves- 
tige of tight clothing, garters, bands, 
neckties, collars, and cuffs. Sponge 
the face and neck and head with cool 
water, or vinegar and water, alcohol 
and water, bay rum, or cologne. Use 
smelling-salts, or water of ammonia, on 
the handkerchief about the face, but not 
too near the nose, mouth, or eyes. Do 
not give stimulants of any kind by the 
mouth unless the patient is fully able 
to swallow. 

Shock. 

Shock is a condition of great depres- 
sion of the vitality in which the physi- 
cal powers are more affected than the 
mental. Even in the greatest cases of 
shock, the sufferer usually remains 

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WHEN TO SEND 

conscious, though he may be " dazed 
and flighty." 

Shock occurs as the result of exten- 
sive burns, gunshot wounds, railway 
and automobile accidents, injuries from 
machinery, and the like. When it is 
severe it simulates death closely. The 
pulse is irregular, almost lost to touch; 
beads of perspiration cover the body; 
the features are pinched and shrivelled ; 
the eyes are sunken; breathing is but 
a sigh. Great restlessness occurs at 
times. All of these may exist for a few 
minutes or for several hours, the patient 
hanging apparently between life and 
death. 

While waiting for the doctor, carry 
the sufferer to a place of comfort. 
Should there be broken bones, support 
these by the clothing, umbrellas, or 
even pieces of fence rails, while carry- 
ing the body from one place to another. 
Loosen all the clothing, and adjust the 

236 



FOR THE DOCTOR 

head slightly lower than the body. 
Apply warmth at once by the use of 
hot water, hot sand, hot bricks, hot 
plates, or hot bottles, meanwhile taking 
extreme care that in doing this the body 
is well protected from burning, through 
these well-meant measures. All the 
sensibility being blunted by the very 
shock, it is impossible to depend upon 
the patient's idea or knowledge of dis- 
comfort from even great heat. The 
care-taker must be a kind of " safety 
thermometer " at this juncture. 

As soon as swallowing is possible, 
stimulate by hot coffee, or whiskey in 
hot milk (tw r o teaspoonfuls of whiskey 
in a glass of milk), every fifteen min- 
utes for four doses. 

Apoplexy, 

A sudden paralysis (often called " a 
stroke ") of a part of the body (usually 
one-half or one side of it) may follow 

237 



WHEN TO SEND 

an apoplexy, or a rupture of a blood- 
vessel of the brain. It is usually terri- 
fying because of its abruptness, unless 
all onlookers are gifted with great pres- 
ence of mind. 

The victim usually falls to the 
ground as though violently struck 
down, and becomes unconscious. The 
face will be red, the breathing will be 
slow, heavy, and noisy, the cheeks puff- 
ing with each inspiration. There may 
be either a general convulsion or only 
slight twitching of the face or limbs. 
If the eyes are observed, one pupil may 
be much larger than the other, or it may 
be unusually small, the pupils being sel- 
dom the same in appearance. 

If no medical aid be present at the 
moment of the attack, little can be done 
beyond loosening the clothing about the 
neck and waist and raising the head a 
little, while the patient is made com- 

238 



FOR THE DOCTOR 

fortable lying down. Cracked ice or 
cold cloths may be applied to the neck 
and head. 

How to Distinguish from Intoxication. 

Apoplexy may be mistaken for in- 
toxication, but in the latter one may 
usually detect the odor of liquor in the 
breath. Moreover, consciousness can 
be aroused to some extent by rubbing, 
pinching, or a forcible application of 
cold water, in even the deepest stupor 
of the drunkard. 

How to Distinguish from Opium Poisoning. 

Apoplexy may be mistaken for 
opium poisoning. In the latter there 
will be no " one-sided " paralysis and 
no noisy breathing. On the contrary, 
the breathing will appear to have 
ceased. The face will be pale, not red, 
as in apoplexy, and both pupils will be 
extremely small. 

239 



WHEN TO SEND 

What to do in Opium Poisoning. 

If one has to deal with opium poison- 
ing before the doctor arrives upon the 
scene, by every possible means keep the 
patient awake and aroused by making 
him walk, even if it be necessary to sup- 
port him on either side. Under no con- 
sideration is he to be allowed to relax 
into stupor ; shout to him, slap his chest 
with wet towels. Use unabated effort 
to keep him warm and awake. 

Asphyxia or Suffocation. 

Suffocation may be caused by pro- 
longed inhalation of the fumes of coke 
or charcoal, or of coal gas from stoves 
in small tenement rooms, or from de- 
fective furnaces in the most comfort- 
able homes. Illuminating gas and 
sewer gas leaking through defective 
pipes and drains may likewise cause 
suffocation. Under any of these con- 
ditions the victim may be found uncon- 

240 



FOR THE DOCTOR 

scious. The face will be purple and 
bloated and the breathing heavy and 
slow. Summon medical aid immedi- 
ately. Should this be delayed, put the 
victim at once in the purest air possible, 
either out of doors, or within, throwing 
all windows and doors widely open. 

Suffocation from Drowning. 

Even though there be no trained at- 
tendant within beck and call of a res- 
cue party, in the event of drowning, life- 
may often be saved if one will be clear- 
headed and resourceful. Instantly 
loosen every vestige of tight clothing 
around the neck, chest, and stomach. 
Then remove all sand, water, and 
mucus from the mouth and nose of the 
victim, pulling the tongue forward to 
do this. At the same time turn him 
face downward, or on his left side, to 
make possible the escape of water from 
the stomach and lungs. 

16 241 



WHEN TO SEND 

He must now be turned face upward, 
with a roll of clothing under his back 
below the shoulder-blades, with his 
head hanging as low as possible. Kneel- 
ing at his head, the attendant grasps his 
arms between the wrists and elbows 
and draws them out horizontally until 
they touch each other above his head. 
Keep them in this position until " one, 
two, three," are slowly counted. After 
this is done, carry both arms down again 
at the side of the body till the elbows 
and forearms are crossed over the pit 
of the stomach. In this position all the 
weight of the attendant is to make pres- 
sure upon the abdomen, and, if it be 
done successfully, there will be heard at 
this time a distinct " grunt " from the 
sufferer. 

These movements must be repeated 
about eighteen (18) times each minute, 
for at least an hour or two, if the pa- 
tient be slow in responding. 

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FOR THE DOCTOR 



CHAPTER XXII 

FRACTURES, DISLOCATIONS, SPRAINS 

Fractures or Broken Bones. 

Railroad accidents, trolley-car col- 
lisions, runaways, automobiling, bicy- 
cling, fallen scaffoldings, are all pro- 
lific in harvests of broken bones. 
Within-doors far less serious causes 
may produce as grave results. Pol- 
ished floors, upturned rugs, and dark 
stairways often contribute to the havoc. 
If a bone, or several bones, be broken, 
and the outside skin is in no wise in- 
jured, the fracture is called a " simple " 
one, and the care of such a condition 
before a surgeon's arrival is not always 
difficult. It is better to do too little 
than too much. Doty advises that, " as 
a rule, the injured person should not 

243 



WHEN TO SEND 

be removed from the position in which 
he is found, following such accidents, 
until an examination be made of the ex- 
tent of the injury." In the mean time 
the injured part of the body must be 
protected from further violence, and 
to secure this it must be given some 
means of support. Such supports are 
known to the surgeon as " splints." 

Splints. 

Temporary splints can be made by 
a by-stander, of shingles, laths, fence 
rails, boards, barrel-staves, branches of 
trees, or boxes. Canes, umbrellas, 
broomsticks, coat-sleeves, shirt-sleeves, 
or trouser-legs stuffed with grass, hay, 
or leaves; pillows, — any of these may 
be utilized for temporary support of a 
broken arm, leg, thigh, or hip, until the 
doctor arrives. To confine the injured 
part to the " splint," bandages may be 
made of handkerchiefs, towels, neck- 

244 



FOR THE DOCTOR 

ties, suspenders, rope, cord, strips of 
clothing, or even green twigs. 

Broken Ribs. 

If the ribs be broken, the condition 
is usually difficult to detect. " Short " 
breathing accompanied by a severe 
" stitch in the side " may point to this 
seat of injury. Before the doctor's ar- 
rival, procure a flannel or muslin ban- 
dage of three-inch width, and com- 
pletely encircle the entire chest with 
four or five turns of it. 

Broken Collar=bone. 

A broken collar-bone is a frequent 
injury, the result of falling with the 
weight of the body upon the shoulders. 
As a result of such an accident, the 
shoulder droops much below that of the 
uninjured side, and the sufferer will 
instinctively support this elbow and 
forearm with the good arm. 

245 



WHEN TO SEND 

This gives a clue to the best mode 
of temporary " splint," which will be a 
wedge-shaped pad, about the size of a 
large fist, placed in the armpit of the 
injured side. This may be made of a 
baseball or boxing glove, or of several 
folded towels or soft newspapers. The 
forearm must then be put across the 
chest, with fingers pointing to the good 
shoulder, and the elbow held as far 
back as possible. The entire side may 
then be given support by two broad 
towels, one enwrapping completely the 
elbow of the maimed side and stretch- 
ing to the opposite or good shoulder. 
The other must confine the injured 
arm, forearm, and hand to the chest. 

Broken Skull. 

What is to be done if the broken 
bones are those of the head? How may 
it be determined that such conditions 
exist? If the injury is extensive and 
severe, there will be shock (as described 

£46 



FOR THE DOCTOR 

above), unconsciousness, and noisy- 
breathing. The pupils of the eye may 
be dilated, one more than the other. 

If no medical aid is at hand, lay the 
patient on his back and insist upon per- 
fect quiet. Place cool cloths or an ice- 
bag on the head. Give no stimulant 
without the surgeon's orders. 

Dislocated Joints. 

Instead of broken bones, there may 
be dislocation of joints, and between 
the two conditions it may be difficult to 
decide. When bones are " fractured," 
the broken fragments give to the in- 
jured part of the body an increased 
motion or " mobility." When they are 
dislocated, their points of union, or 
" the joints," are often so out of place 
that all motion is seriously diminished. 

An attempt to correct any disloca- 
tion must be made by no other than the 
doctor or surgeon. Until one comes 

247 



WHEN TO SEND 

the only wise thing to do is to make the 
patient comfortable. For this it may 
be necessary to improvise a bed, using 
a stretcher, a door, or a broad shutter 
for the purpose. In addition, protect 
the injured part as directed for frac- 
ture, by temporary supports of cloth- 
ing or pillows, boards and similar 
devices. 

Dislocated Jaw. 

The only dislocation safely to be 
cared for by unskilled hands is that of 
the lower jaw. This can be replaced 
by wrapping the thumbs of both hands 
securely in a handkerchief, napkin, or 
towel, and placing one of them on either 
side of the mouth upon the back or 
" molar teeth." If, in this position, the 
lower jaw is very firmly pressed down 
and back, it will usually, with a sharp 
" click," spring or slide into its proper 
place. 

248 



FOR THE DOCTOR 

Sprains. 

Sprains may frequently occur from 
sudden twisting or wrenching of the 
joints. They are apt to occur unex- 
pectedly, are very painful, and call for 
prompt care. In addition to the pain 
there will be rapid swelling and dis- 
colored skin, the " black and blue " so 
familiar in even slight injuries or 
wounds. 

The injured member should be 
slightly raised and the inflamed part 
covered with cold cloths. Towels or 
handkerchiefs filled with cracked ice 
may be used, if a rubber ice-cap or -bag 
is not at hand. A bicycle tire or the 
inner section of an automobile tire may 
be filled with ice and splendidly serve 
its purpose of comfort. By the time 
this is accomplished, the doctor's ad- 
vice is the only safe one to seek and 
follow. 



249 



WHEN TO SEND 



CHAPTER XXIII 

POISONS 
Poisoning, 

Whether poisoning be accidental 
or intentional, the consequences thereof 
may be equally serious in either case. 
Life is put in equal jeopardy by the 
neglected medicine-closet containing 
unlabelled bottles and by the well- 
planned effort at self-destruction. To 
guard against the first catastrophe, 
" the ounce of prevention " will provide 
for the exact labelling of every bottle, 
and for the special blue or brown bottle 
with roughened surface which makes it 
possible to detect, even " in the dark/ 5 
that one has the liniment bottle, or the 
strong ammonia, or the carbolic acid, 
and not the lime water. 

Treatment, 

Two things are to be done in the 
management of poisoning: the first be- 

250 



FOR THE DOCTOR 

ing, to remove the poison, if possible; 
the second, to make its action harmless 
(to counteract it). The remedy used 
to counteract a poison is called its " an- 
tidote " ; that used to remove the poison, 
ordinarily by emptying the stomach, is 
called an " emetic." 

Before medical aid can be sum- 
moned, it will be generally safe to at- 
tempt to remove the poison by produc- 
ing vomiting. This can be done me- 
chanically, — i.e., by tickling the back of 
the throat with the forefinger or a 
feather, or by the use of certain drinks. 
Among the latter are- — 

Alum,, — One tablespoonful dissolved 

in half a pint of tepid water. 
Ipecac, — Two tablespoonfuls of sy- 
rup of ipecac. 
Mustard, — One tablespoonful mixed 

in half a pint of water. 
Salt, — Two tablespoonfuls in half 
a pint of tepid water. 

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WHEN TO SEND 

White Vitriol, — One-half tea- 
spoonful in half a glass of tepid 
water. 
For convenience and ready refer- 
ence, we tabulate below the common 
poisons, with the most practical treat- 
ment in each individual condition. 

Acid, Carbolic* 

Empty the stomach and give olive 
oil, one quarter of a pint in one pint of 
water, or give milk, or white of egg in 
water. 

Acid, Hydrochloric (Spirit of Salt); Acid, 
Oxalic (Salt of Sorrel or Salt of Lemons) ; 
Acid, Sulphuric (Oil of Vitriol). 

For none of these must an emetic be 
given. Counteract the poison by giv- 
ing whiting or chalk, wall plaster, 
washing soda, or soap and water. Fol- 
low this by giving milk and egg, olive 
oil, or thick gruel. 

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FOR THE DOCTOR 

Acid, Prussic. 

Give an emetic very promptly. 
When the stomach is thoroughly emp- 
tied, follow with milk, or olive oil, or 
white of egg. 

Ammonia, Strong; Caustic Potash; Caustic 
Soda* 

Do not give any emetic, but counter- 
act the poison by giving vinegar in 
water, or lemon juice. Follow with 
olive oil, one quarter of a pint in one 
pint of water, or white of egg. 

Corrosive Sublimate. 

Before using an emetic here, give 
large quantities of milk, or white of egg 
mixed with water. After this has been 
done, use an emetic for thorough emp- 
tying of the stomach. 

Phosphorus (Rat Paste, Matches). 

Empty the stomach thoroughly by 
the use of a few grains of blue vitriol 
-dissolved in a quarter of a pint of tepid 

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WHEN TO SEND 

water. Use magnesia freely, as a 
purge. Follow these with milk and 
white of eggs, but do not give oil or fats 
in any form. 

Arsenic, (Fowler's Solution, Rough on Rats, 
Paris Green). 

Give a thorough and prompt emetic. 
If there be any medicine at hand con- 
taining iron, give it to counteract the 
poison. Follow with milk and eggs, 
olive oil, or barley water. 

Antimony (Tartar Emetic); 

Cause free vomiting by large quanti- 
ties of tepid water. Counteract the 
poison with strong tea. After all vom- 
iting has ceased, give white of egg in 
water or milk, abundantly. 

Poisonous Plants (" Deadly Nightshade," 
"Jimson Weed," Toadstools, Tobacco). 

Produce vomiting by giving an 

emetic. Follow with strong coffee or 

brandy. 

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FOR THE DOCTOR 

Spoiled Food (Ptomaine Poisoning). 

Produce vomiting by giving an 
emetic, and purge with castor oil. Fol- 
low this with strong coffee or brandy. 

Lunar Caustic. 

Produce prompt vomiting by two 
tablespoonfuls of common salt in a tum- 
blerful of warm water. Follow this 
by large quantities of white of egg in 
water. 

Opium (Laudanum, Morphine, Paregoric, 
" Soothing Syrups "). 

The management of opium poisoning 
is carefully described in a previous sec- 
tion. 

It may not be amiss to suggest the 
outfit of an emergency closet in the 
home: 

Absorbent cotton, }/% pound. 

Clean cotton batting, 1 roll. 

Clean muslin or linen, cut and folded into 
squares of various sizes (4x4 inches, 6x6 
inches), kept in covered glass jars. 
%55 



WHEN TO SEND 

Adhesive plaster, 2 inches wide, a five-yard 

roll or tin spool. 
"New skin," a small bottle. 
Prepared mustard leaves. 
Prepared tooth or dental plasters. 
Paraffin or waxed paper, 1 roll. 
Spirit lamp. 

Medicine-droppers (kept in closed bottles). 
Alcohol. Glycerin. 

Alum (powdered). Hartshorn. 

Aromatic ammonia. Ipecac, syrup of. 
Baking soda. Lime water. 

Borax. Linseed oil. 

Brandy. Peroxide of hydrogen. 

Camphor, water of. Paregoric. 
Camphor, spirit of. Sweet oil. 

Castor oil. Sweet spirits of nitre. 

Witch-hazel. 

For bandages, made in and for 
emergencies, the housewife is prudent 
who has a clean, safe, dust-proof 
" stow-away " for old, soft, clean 
sheets, soft, old towels and napkins. 
The same housewife will doubtless 
keep in generous supply for the regu- 
lar cleansing or " disinfection " of all 

206 



FOR THE DOCTOR 

the sinks and privy-bowls in the 
house, — 

Chlorinated lime, used by dissolving 

one pound to one gallon of water. 

Copperas, used by dissolving two 

pounds to one gallon of water. 
Washing soda, used by dissolving 
one-quarter of a pound in one gal- 
lon of boiling water. 

Above all, she will not forget the two 
surest disinfectants known, sunshine 
and fresh air ; the house and home plen- 
tifully provided with these is the one 
that persuades health to abide within 
its walls. Of her who rules therein it 
may usually be said, — 

" She looketh well to the ways of her household; 
Her children rise up and call her blessed; 
She stretcheth out her hand to the poor; 
Strength and dignity are her clothing; 
And she laugheth at the time to come!" 



17 257 



INDEX 



Acne, a result of constipation, 

56 
Adenoids, cause of poor ar- 
ticulation, 161 
of poor hearing, 148 
causing catarrh of middle 

ear, 149 
description of, 148 
face in, 148 
signs of, 140 
sore throat in, 31 
treatment of, 150 
Anaemia, headache of, 59 

pallor of, 60 
Antidotes, 251 
Antiseptic poultice, 221 
Apathetic child, 177 
Apoplexy, description of, 238 
distinguished from intox- 
ication, 239 
from opium poisoning, 
239 
treatment of, 238 
Arch of foot, description of, 

170-171 
Asphyxia, cause of, 240 
treatment of, 240 

Babies' cries, 13 
Bath, mustard, 109 
Bathing, reason for daily, 21 
Bed-wetting, cause of, 121 
Bleeding, arterial, 222 
treatment of, 222 
capillary, 224 

treatment of, 224 
from foot, treatment of, 
227 



Bleeding from forearm, treat- 
ment of, 226 
hand, treatment of, 226 
leg, treatment of, 227 
mouth, treatment of, 

224 
neck, treatment of, 225 
nose, treatment of, 225 
shoulder, treatment of, 

226 
thigh, treatment of, 226 
upper arm, treatment 
of, 226 
venous, 223 

treatment of, 224 
Boils, care of, 76 
cause of, 76 
treatment of, 77 
when ripe, 77 
Bowel trouble, 50 
Bow legs, cause of, 169 
Box-shaped skull, 196 
Brachycephalic skull, 196 
Breast, cause of pigeon, 153 

result of pigeon, 153 
Breathing, cause of defective, 
152 
mouth, 149 

result of defective, 153 
Brush, need for tooth, 156 
Burns, extensive, 229 

treatment of, 229 
from acids, treatment of, 

230 
from alkalies, treatment 

of, 230 
slight, 228 
treatment of, 228 



259 



INDEX 



Card, Snellen test, 139 
Caries, cause of, 156 
result of, 157 
sign of, 157 
Care of teeth, proper, 159 
Catarrh of middle ear, fever 

in, 42 
Characteristic ear, in defec- 
tive children, 198 
hand, in defective chil- 
dren, 201 
mouth, in defective chil- 
dren, 200 
nose, in defective children, 
199 
Chest, cause of flat, 167 

result of flat, 168 
Chicken-pox, contagion of, 90 
incubation period of, 82 
mode of onset, 89 
rash in, 90 
treatment of, 91 
Child, apathetic, 177 

excitable, 179 
Classification of defective 

children, 204 
Clinical thermometer, 36 
Cold, a precursor of croup, 26 
of measles, 25 
of whooping-cough, 28 
Colds, frequent, accompany- 
ing rheumatism, 23 
prevention of, 20 
sign of adenoids, 23 
simple, 22 
Colic, cry of, 16 
Collar-bone broken, cause of, 
245 
treatment of, 246 
Common physical defects, def- 
inition of, 136 
Conjunctivitis, contagion of, 
96 
gonorrheal, 96 
treatment of, 96 



260 



Constipation, cause of, 53 

eczema arising from, 63 

headache arising from, 55 

prevention of, 52 

results of, 54 

significance of, 53 

treatment of, 53 

varieties of, 53 
Contagion, of chicken-pox, 90 

of conjunctivitis, 97 

of pink eye, how spread, 
96 

of scarlet fever, when 
greatest, 73 
Convulsions, cause of, 105 

description of, 106 

in indigestion, 107 

in meningitis, 108 

in pneumonia, 107 

progress of, 106 

repetition of, 107 

in scarlet fever, 107 

treatment of, 109 
Cough, night, 29 
Croup, signs of false, 27 

treatment of, 28 
Crusted ringworm, 67 
Curvature, spinal, causes of, 
164 
description of, 166 
recognition of, 166 
treatment of, 166 

Dandruff, 75 

how distinguished from 
lice, 75 
Deafness, resulting from 
mumps, 94 
temporary, 150 
causes of temporary, 150 
treatment of temporary, 
151 
Death, sudden, in meningitis, 

49 
Decayed teeth, signs of, 156 



INDEX 



Defects of breathing, causes 
of, 152 
results of, 153 
of hearing, causes of, 147 
causing round should- 
ers, 164 
how detected, 146 
indications of, 146 
why difficult to find, 
144 
posture, causes of, 162 
definition of, 163 
varieties of, 163 
speech, causes of, 160, 161 

treatment of, 161 
teeth, causes of, 154 
results of, 155 
treatment of, 155 
vision, causes of, 140 
causing round should- 
ers, 138 
indications of, 138 
tests for, 139 
treatment of, 140, 141 
Deformed jaws, 155 
Delay in walking, 178 
Delayed speech, 182 
Delirium, fever in, 41 
Desks, ideal school, 141 
Diarrhoea, acute, 50 
chronic, 50 

need of careful report in, 
51 
Diphtheria, cold a precursor 

of, 26 
Disease of ear, neglected, 144 

unsuspected, 144 
Diseases, contagious, how 
spread, 80 
nervous, 103 

prevention of nervous, 104 
Drooling, in defective chil- 
dren, 201 
Drowning, treatment of, 241 
Drug eruptions, 69 



Ear, catarrh of middle, 149 

foreign bodies in, 152 
Earache, cry of, 17 

treatment of, 17 
Eczema, distinguished from 
itch, 65 
from ringworm, 66 
from constipation 63 
from irritation of lice, 64 
scaling of skin in, 70 
Emergency outfit for house- 
hold, 255-256 
Emetics, 251 

Epilepsy, treatment of, 112 
Eruption of chicken-pox, 90 
German measles, 85 
measles, 83 
scarlatina, 88 
Eruptions, causes of skin, 62 
drug, 69 
varieties of, 62 
Examination, physical, of 

school children, 137 
Eye, pink, treatment of, 96 
Eye-strain, headache in, 58 

vomiting in, 45 
Excitable child, 179 

Fainting, causes of, 234 

treatment of, 234 
Fatigue, description, 126 
definition of, 125 
in the feeble-minded, 185 
symptoms of, 126 
treatment of, 127 
Favus, distinguished from ring- 
worm, 67 
Feeble-minded children, inat- 
tention in, 186 
lack of imitation, in, 188 
physical marks of, 190 
the play of, 184 
Fever, of delirium, 41 
high, 38 
of indigestion, 40 



261 



INDEX 



Fever of malaria, 44 

of middle-ear disease, 42 
moderate, 38 
of pneumonia, 43 
of scarlatina, 42 
significance of, 39 
of sore throat, 41 
sponging in, 41 
of tuberculosis, 44 
of typhoid, 44 
Finger sucking, 122 
First sign of mental retarda- 
tion, 177-180 
Fits, causes of, 110 

description of, 110 
Flat chest, causes of, 153, 168 
results of, 168 
foot, causes of, 172 
definition of, 169 
description of, 173 
prevention, of, 173 
results of, 172 
test for, 173 
treatment of, 173 
Foreign bodies in ear, 152 
Fracture, cause of, 243 

general treatment of, 244 
of collar-bone, cause of, 
245 
treatment of, 246 
ribs, treatment of, 245 
skull, effects of, 246 
symptoms of, 247 
treatment of, 247 
Frostbite, treatment of, 232 

Gait, characteristic in feeble- 
minded children, 184 
Garments, infants, 14 
German measles, incubation 
period of, 82 
rash in, 85 

swollen glands in, 85 
treatment of, 86 
Glands, parotid, location of, 92 



Grippe, early sign of, 26 
Groove, Harrison's, 59, 197 

Habit, cry of, 18 
Habit spasm, 117 
Harrison's groove, 59, 197 
Headache of anaemia, 59 
constipation, 55 
eyestrain, 58 
nasal obstruction, 57 
from poor ventilation, 56 
Hearing, poor, causes of, 147 
causing round should- 
ers, 164 
how detected, 146 
tests for, 146 
why difficult to detect, 
144 
Heatstroke, description of, 
231 
treatment of, 231 
Hives, appearance of, 68 

causes of, 69 
Hot salt solution, 218 
Hunger, cry of, 15 
Hydrocephalic skull, 194 
Hysteria, 116 

Idio-imbecile, characteristics, 

207 
Idiot geniuses, 211 

the excitable, 206 
Idiocy, profound, sign of, 205 

superficial, sign of, 206 
Imbecile, high-grade, 211 

low-grade, 208 

middle-grade, 209 
Imitation, lack of, 188 
Incontinence, cause of, 121 
Incubation, of chicken-pox, 82 

of diphtheria, 82 

of German measles, 82 

of measles, 82 

of mumps, 82 

period of, definition, 81 



262 



INDEX 



Incubation of pneumonia, 82 

of scarlatina, 82 

of small-pox, 82 

of whooping-cough, 82 
Indigestion, cry of, 16 

fever with, 40 
Infection, method of spread- 
ing, 80 
Infectious diseases, definition 

of, 79 
Insect stings, care of, 221 
Intestinal obstruction, vomit- 
ing with, 47 

worms, vomiting with, 46 
Itch, 65 

mite, 66 

Jaw, dislocation of, 248 
Jaws, deformed, 155 
Joints, dislocations of, 247 

Knock-knee, causes of, 169 

Lack of attention, 186 

oxygen from nasal ob- 
struction, 57 
from poor ventilation, 
56 
Lice, to distinguish dandruff 

from, 75 
Living-room, proper tempera- 
ture of, 57 

Malaria, fever in, 44 
Malnutrition, pallor of, 61 
Masturbation, how detected, 
124 
prevention of, 125 
treatment of, 125 
Measles, a cause of tubercu- 
losis, 83 
early signs of, 83 
German, incubation pe- 
riod of, 82 
treatment of, 86 
incubation period of, 82 
rash in, 83 



Measles, scaling in, 74 

treatment of, 84 
Meningitis, sudden death in, 49 

vomiting in, 48 
Mental retardation, first sign 

of, 177-180 
Mentally deficient children, 178 
Micro-organisms, 79 
Microcephalic skull, 194 
Middle-ear disease, fever in, 42 
Mouth breathing, effect of, 149 
Mustard bath, 109 
Mumps, after effects of, 94 

appearance of, 92 

incubation period of, 82 

mode of onset, 92 

treatment of, 93 

Nasal obstruction, causing 

lack of oxygen, 57 
Need for regular sleep in chil- 
dren, 103 
Nervous diseases, prevention 
of, 104 
system, unstable in chil- 
dren, 105 
Nettle rash, appearance of, 68 

causes of, 69 
Night cough, 29 
terrors, 113 
Normal temperature, 37 

Opium poisoning, treatment 
of, 240 

Pacifier, 18 
Pallor of anaemia, 60 
malnutrition, 61 
Physical examination of school 

children, 137 
Pigeon breast, cause of, 167 

results of, 168 
Pink-eye, contagion of, 96 

treatment of, 96 
Pneumonia, incubation period 
of, 82 



263 



INDEX 



Poisoning, 250 

ammonia, 253 
antimony, 254 
arsenic, 254 
carbolic acid, 252 
corrosive sublimate, 253 
from spoiled food, 255 
hydrochloric acid, 252 
lunar caustic, 255 
opium, 255 
oxalic acid, 252 
phosphorus, 253 
plants, 254 
prussio acid, 253 
Poor ventilation, cause of 
headache, 56 
cause of lack of oxygen, 
56 
Posture defects, causes of, 162 
definition, 163 
varieties, 163 
Pressure on brain, 195 
Prevention of vomiting in in- 
fancy, 45 
Proper care of teeth, 158 
Proper temperature of living 
room, 57 

Quarantine, 81 
Quinsy, 34 

Rhachitic rosary, 197 
Regular sleep, need of, 104 
Rheumatism, eczema of, 64 

frequent colds of, 23 
Ribs, broken, treatment of, 245 
Rickets, cry of, 19 

diarrhoea in, 51 
Ringworm, crusted, 67 

distinguished from ec- 
zema, 66 

distinguished from favus, 
67 

scalp, 66 
Round shoulders, cause of, 164 



Scarlatina, early signs of, 87 
incubation period of, 82 
rash in, 88 
results of, 89 
scaling in, 71 
strawberry tongue, 88 
vomiting in, 33, 42, 48 
when most contagious, 73 
School desks, ideal, 141 
lunches, 61 
rooms, ideal, 143 
seats, ideal, 142 
Shock, description of, 235 

treatment of, 236 
Simple colds, 22 

sore throat, 32 
Skin, characteristic, in defec- 
tive children, 201 
causes of eruptions, 62 
eruption of, 62 
scaling of, in eczema, 70 
in measles, 74 
in scarlatina, 71 
varieties of eruption, 62 
Skull, shape of in feeble-mind- 
ed children, 192 
size of in feeble-minded 

children, 193 
hydrocephalic, 194 
microcephalic, 194 
box-shaped, 196 
brachycephalic, 196 
broken, symptoms of, 247 
broken, treatment of, 247 
Smallpox, incubation period 

of, 82 
Snellen test-card, description 
of, 139 
use of, 140 
Sore throat, with adenoids, 
31 
fever in, 33 
in diphtheria, 33 
in quinsy, 34 
in scarlatina, 33 



264. 



INDEX 



Speech, defects of, 160 

causes of defects of ,160, 161 
delayed, 161 

treatment of defects of, 161 
Spells, description of, 111 
Spine, curvature of, 165 

causes of curvature, 164 
description of curvature, 

165 
recognition of curvature, 

165 
treatment of curvature, 

166 
tuberculosis of, 167 
causes of tuberculosis, 167 
curvature of, as distin- 
guished from tubercu- 
losis of spine, 166 
treatment of tuberculo- 
sis, 167 
Splints, — how made, 244 
Sponging in fever, 41 
Sprains, treatment of, 249 
Styes, causes of, 138 
St. Vitus' dance, causes of, 114 
description of, 115 
early stages of , 115 
treatment of, 116 
Sunstroke, description of, 231 

treatment of, 232 
Swollen glands, in German 

measles, 85 
Suffocation, causes of, 240-241 
treatment of, 241 

Tartar, causes of, 156 

results of, 157 
Teeth, defective, causes of, 154 
results of, 155 
treatment, 155 
proper care of, 159 
Temperature, normal, 37 
Temporary deafness, causes 
of, 150 
treatment of, 151 



Tonsils, description of, 147 
enlarged, causes of poor 
hearing, 149 
treatment of, 150 
Tonsillitis, 34 
Tooth-brush, need for, 155 
Trachoma, appearance of, 98 
contagion of, 98 
prevention of, 99 
Tuberculosis, fever in early, 44 
of spine, 167 
vomiting in early, 46 
Typhoid, fever at onset of, 44 
vomiting at onset of, 47 

Vision poor, causes of, 140 

causing round should- 
ers, 138 
indications of, 138 
tests for, 139 
treatment of, 140, 141 
Vomiting in early tuberculo- 
sis, 46 

early typhoid, 47 

eye-strain, 45 

infancy, causes of, 45 
prevention of, 45 

intestinal obstruction, 47 
worms, 46 

meningitis, 48 

Walking, delay in, 178 
Weighing the baby, 16 
Whooping-cough, incubation 
period of, 82 
results of, 29 
signs of, 28 
Worms, intestinal, vomiting 

with, 46 
Wounds, varieties of, 218 
incised, care of, 218 
definition of, 218 
lacerated, care of, 220 

definition of, 219 

punctured, care of, 221 

definition of, 220 



265 



MAY 1 1913 



